Individual
MRS. CREDONNA L MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
5 MEDICAL PARK DR, STE 101, BENTON, AR 72015-3729
(501) 778-3868
(501) 317-1704
Mailing address
5 MEDICAL PARK DR, STE 101, BENTON, AR 72015-3729
(501) 778-3868
(501) 317-1704
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
A#90
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131885720
—
AR
01
—
621697738
TAX ID #
AR
Enumeration date
02/21/2006
Last updated
11/03/2011
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