Individual provider Active NPI

Cheryl Miller, PA-C

  • Physician Assistant
  • Tacoma, WA
National Provider Identifier
1417412875
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1171662
Practice address
9040 Jackson Ave
Tacoma, WA 98431-2102
Phone
(253) 968-2252
NPI assigned
Feb 9, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1171662 Primary

Addresses

Primary practice location

9040 Jackson Ave
Tacoma, WA 98431-2102

Mailing address

6600 Van Aalst Blvd
Fort Benning, GA 31905-2102

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260202002591 WA Practitioner - Physician Assistant 6204314032 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1 Zotec Way
Carmel, IN 46032-0052

PO Box
Los Angeles, CA 90084

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Olympia Emergency Care Physicians PLLC CurrentSince Feb 1, 2026 Accepting new patients

Locations

3900 Capital Mall Dr SW
Olympia, WA 98502
Phone (360) 704-4743

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1549670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1417412875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 VAN AALST BLVD",
            "city": "FORT BENNING",
            "state": "GA",
            "postal_code": "319052102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984312102",
            "telephone_number": "253-968-2252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "CHERYL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-09",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": "1171662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.