Provider Demographics
NPI:1386033298
Name:MILES, AMBER (CFNP)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422-9055
Mailing Address - Country:US
Mailing Address - Phone:601-764-4494
Mailing Address - Fax:601-764-4649
Practice Address - Street 1:20 S SIXTH ST
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-9055
Practice Address - Country:US
Practice Address - Phone:601-764-4494
Practice Address - Fax:601-764-4649
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR882600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily