Provider Demographics
NPI:1447840681
Name:MILLER, TRACI LAYNE (RD)
Entity type:Individual
Prefix:MS
First Name:TRACI
Middle Name:LAYNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:TX
Mailing Address - Zip Code:75444-0044
Mailing Address - Country:US
Mailing Address - Phone:903-497-8668
Mailing Address - Fax:
Practice Address - Street 1:2465 FM 1799
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-4067
Practice Address - Country:US
Practice Address - Phone:190-349-7866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82554133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal