Provider Demographics
NPI:1962270157
Name:MYLES, MICHAEL (NP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MYLES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 S FOSTER DR APT 37
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4148
Mailing Address - Country:US
Mailing Address - Phone:225-993-1778
Mailing Address - Fax:
Practice Address - Street 1:152 S FOSTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4100
Practice Address - Country:US
Practice Address - Phone:225-993-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LANA363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health