Individual ProviderShannon MillerNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1600 SW 119th St, Oklahoma City, OK 73170-4908(405) 425-8100PECOS EnrollmentBased on the most recent information from CMS, provider Shannon Miller is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1063850766Provider TypeIndividualFull NameMiller, ShannonCredentialAPRN-CNPGenderFemaleSole ProprietorNoEnumeration Date6/5/2013Last Updated11/8/2019Contact InformationPractice LocationPractice Address1600 SW 119th St, Oklahoma City, OK 73170-4908Phone(405) 425-8100Fax(405) 425-8109Mailing LocationMailing Address5300 N Independence Ave Ste 280, Oklahoma City, OK 73112-5555Phone(405) 425-8100Fax(405) 425-8109Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense78164OklahomaCode363L00000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense78164Oklahoma