Provider Demographics
NPI:1619796091
Name:MILLER, BAYLEIGH JUHREE (LPN)
Entity type:Individual
Prefix:
First Name:BAYLEIGH
Middle Name:JUHREE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 W KEETOOWAH ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3497
Mailing Address - Country:US
Mailing Address - Phone:918-708-9009
Mailing Address - Fax:918-708-1714
Practice Address - Street 1:1640 W KEETOOWAH ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3497
Practice Address - Country:US
Practice Address - Phone:918-708-9009
Practice Address - Fax:918-708-1714
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK219580164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse