Provider Demographics
NPI:1346809662
Name:MILES, STEPHANIE SMITH (AGNP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SMITH
Last Name:MILES
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 SILAS CREEK PKWY STE 6B
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5000
Mailing Address - Country:US
Mailing Address - Phone:336-999-7009
Mailing Address - Fax:336-900-1078
Practice Address - Street 1:2200 SILAS CREEK PKWY STE 6B
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5000
Practice Address - Country:US
Practice Address - Phone:336-999-7009
Practice Address - Fax:336-900-1078
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAG06190099363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner