Individual provider Active NPI

Dana Miller

  • Medical-Surgical Registered Nurse
  • Gautier, MS
National Provider Identifier
1023607918
Registry record updated Jan 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical-Surgical Registered NurseTaxonomy code 163WM0705X
License
871462 Issued in MS
Practice address
330B Highway 90
Gautier, MS 39553-5744
Phone
(228) 497-0690
NPI assigned
Jan 14, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 14, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical-Surgical Registered Nurse 163WM0705X 871462 MS Primary

Addresses

Primary practice location

330B Highway 90
Gautier, MS 39553-5744

Mailing address

3407 Shamrock CT
Gautier, MS 39553-5337
Phone (228) 497-0690

Other identifiers 1

IdentifierTypeStateIssuer
00018214MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
871462MSMDMedical-Surgical Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610582400000",
    "number": "1023607918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3407 SHAMROCK CT",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "395535337",
            "telephone_number": "228-497-0690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330B HIGHWAY 90",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "395535744",
            "telephone_number": "228-497-0690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "DANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-14",
        "last_updated": "2021-01-14",
        "certification_date": "2021-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "MS",
            "license": "871462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00018214",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gautier, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.