Provider Demographics
NPI:1851254254
Name:MYLES, JERRY WAYNE
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:WAYNE
Last Name:MYLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2464 HARNEY ST APT 2
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-3646
Mailing Address - Country:US
Mailing Address - Phone:402-905-7512
Mailing Address - Fax:
Practice Address - Street 1:2464 HARNEY ST APT 2
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3646
Practice Address - Country:US
Practice Address - Phone:402-905-7512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide