Individual provider Active NPI

Melvina Arleen Miller, LPN

  • Licensed Practical Nurse
  • Port Jervis, NY
National Provider Identifier
1477053353
Registry record updated Feb 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
246451-1 Issued in NY
Practice address
47 Edgewater LN
Port Jervis, NY 12771-5153
Phone
(845) 672-4191
NPI assigned
Feb 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 246451-1 NY Primary

Addresses

Primary practice location

47 Edgewater LN
Port Jervis, NY 12771-5153

Mailing address

47 Edgewater LN
Port Jervis, NY 12771-5153
Phone (845) 672-4191

Other identifiers 1

IdentifierTypeStateIssuer
246451-1MedicaidNY

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
246451-1NYMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1518739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518739200000",
    "number": "1477053353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 EDGEWATER LN",
            "city": "PORT JERVIS",
            "state": "NY",
            "postal_code": "127715153",
            "telephone_number": "845-672-4191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 EDGEWATER LN",
            "city": "PORT JERVIS",
            "state": "NY",
            "postal_code": "127715153",
            "telephone_number": "845-672-4191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "MELVINA",
        "middle_name": "ARLEEN",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-16",
        "last_updated": "2018-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "246451-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "246451-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jervis, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2018; 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.