Provider Demographics
NPI:1487738050
Name:MILES, KASEY LYNN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:LYNN
Last Name:MILES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 FARAON ST STE 160
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3829
Mailing Address - Country:US
Mailing Address - Phone:816-671-4852
Mailing Address - Fax:816-671-4839
Practice Address - Street 1:5301 FARAON ST
Practice Address - Street 2:SUITE 160
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3512
Practice Address - Country:US
Practice Address - Phone:816-671-4852
Practice Address - Fax:816-671-4839
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002005056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200605810AMedicaid
MO1487738050Medicaid
MOP00735198OtherRAILROAD MEDICARE
MOP00735198OtherRAILROAD MEDICARE