Individual
STACEY L MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
4612 MILLENNIUM DR, GENESEO, NY 14454-1197
(607) 302-0442
Mailing address
909 BIRCH GARDEN DR, LONGS, SC 29568-9507
(607) 738-4244
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F403088-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06208162
—
NY
Enumeration date
08/03/2020
Last updated
02/24/2026
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