Active NPI
Jerry L. Miller, M.A.
- Clinical Psychologist
- Fayetteville, NC
National Provider Identifier
1235257288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 945
- Practice address
- 930 Cambridge St Ste 107
Fayetteville, NC 28303-5356 - Phone
- (910) 433-2307
- NPI assigned
- Mar 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 945 | NC | Primary |
Addresses
Primary practice location
930 Cambridge St Ste 107
Fayetteville, NC 28303-5356
Mailing address
930 Cambridge St Ste 107
Fayetteville, NC 28303-5356
Phone (910) 433-2307
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6107454 | Medicaid | NC |
Other names 1
- Jerry L Miller
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 945 | NC | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235257288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "930 CAMBRIDGE ST STE 107",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283035356",
"telephone_number": "910-433-2307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "930 CAMBRIDGE ST STE 107",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283035356",
"telephone_number": "910-433-2307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "JERRY",
"middle_name": "L.",
"credential": "M.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "945",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6107454",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JERRY",
"last_name": "MILLER",
"middle_name": "L",
"credential": "M.A.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.