Active NPI
Jacob Miller
- Family Nurse Practitioner
- Portland, OR
National Provider Identifier
1902619778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 10064246
- Practice address
- 1125 NW 9TH Ave Apt 108
Portland, OR 97209-2865 - Phone
- (503) 896-1445
- NPI assigned
- Jan 27, 2025
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 10064246 | OR | Primary |
Addresses
Primary practice location
1125 NW 9TH Ave Apt 108
Portland, OR 97209-2865
Mailing address
1125 NW 9TH Ave Apt 108
Portland, OR 97209-2865
Phone (503) 804-1823
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787788800000",
"number": "1902619778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1125 NW 9TH AVE APT 108",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972092865",
"telephone_number": "503-804-1823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1125 NW 9TH AVE APT 108",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972092865",
"telephone_number": "503-896-1445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "JACOB",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-01-27",
"last_updated": "2026-08-27",
"certification_date": "2026-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OR",
"license": "10064246",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.