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Individual
MS. EBONY MILLER
Active
Individual
MS. EBONY MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10002711A
IN
363A00000X
Physician Assistant
Primary
56608
CA
363AM0700X
Medical Physician Assistant
10002711A
IN
363AS0400X
Surgical Physician Assistant
PA15641
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10002711A
INDIANA LICENSE NUMBER
IN
01
—
56608
CALIFORNIA LICENSE
CA
01
—
PA15641
TEXAS LICENSE
TX
Enumeration date
05/17/2019
Last updated
12/27/2023
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