Individual
JACKIE S MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1607 E US HIGHWAY 136, ALBANY, MO 64402-8223
(660) 726-3311
Mailing address
1607 E US HIGHWAY 136, ALBANY, MO 64402-8223
(660) 726-3311
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
104860
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
246870067
—
MO
Enumeration date
06/12/2006
Last updated
12/07/2017
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