Provider Demographics
NPI:1871946160
Name:MILLER, BRENT JORDAN (APRN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:JORDAN
Last Name:MILLER
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8312 HEDGES AVE
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-3440
Mailing Address - Country:US
Mailing Address - Phone:816-316-9835
Mailing Address - Fax:
Practice Address - Street 1:9400 EAST 350 HIGHWAY
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133
Practice Address - Country:US
Practice Address - Phone:816-251-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016019762363LF0000X
KS53-77307-021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily