Provider Demographics
NPI:1366324147
Name:MILES, KEVIN E I (BHCM, PRS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:MILES
Suffix:I
Gender:M
Credentials:BHCM, PRS
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 156
Mailing Address - Street 2:
Mailing Address - City:TATUMS
Mailing Address - State:OK
Mailing Address - Zip Code:73487-0156
Mailing Address - Country:US
Mailing Address - Phone:405-888-4027
Mailing Address - Fax:
Practice Address - Street 1:401 S MERIDIAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1013
Practice Address - Country:US
Practice Address - Phone:405-888-4027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171WH0202X
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No171WH0202XOther Service ProvidersContractorHome Modifications