Provider Demographics
NPI:1730229394
Name:MILLER, PAULA SUE (NP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:SUE
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 KING ARTHUR BLVD STE 124
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5818
Mailing Address - Country:US
Mailing Address - Phone:972-999-5265
Mailing Address - Fax:972-899-0362
Practice Address - Street 1:2560 KING ARTHUR BLVD STE 124
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-5818
Practice Address - Country:US
Practice Address - Phone:972-999-5265
Practice Address - Fax:972-899-0362
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX538607363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170836407Medicaid
TX170836406Medicaid
TX170836408Medicaid
TX170836408Medicaid
TX8K8557Medicare PIN
TX8K8567Medicare PIN
TX8K8568Medicare PIN