Provider Demographics
NPI:1407851991
Name:MILES, BRANDEE (RN FNP)
Entity type:Individual
Prefix:MRS
First Name:BRANDEE
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3810
Mailing Address - Country:US
Mailing Address - Phone:817-274-0097
Mailing Address - Fax:817-274-0327
Practice Address - Street 1:1635 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3810
Practice Address - Country:US
Practice Address - Phone:817-274-0097
Practice Address - Fax:817-274-0327
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX664660363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168771702Medicaid
8C6618Medicare ID - Type UnspecifiedMEDICARE - AGAPE CLINIC
8E0466Medicare ID - Type UnspecifiedMEDICARE - ACCENT FAMILY
TX168771702Medicaid