Provider Demographics
NPI:1588966626
Name:MILES, KIA DELEASE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:KIA
Middle Name:DELEASE
Last Name:MILES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 TROTTERS WALK
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-8115
Mailing Address - Country:US
Mailing Address - Phone:210-294-1918
Mailing Address - Fax:
Practice Address - Street 1:260 TROTTERS WALK
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-8115
Practice Address - Country:US
Practice Address - Phone:210-294-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188118363LF0000X
TX816877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily