Provider Demographics
NPI:1962807677
Name:ADAMSON, MYLES
Entity type:Individual
Prefix:
First Name:MYLES
Middle Name:
Last Name:ADAMSON
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 1:818 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5433
Mailing Address - Country:US
Mailing Address - Phone:903-236-8600
Mailing Address - Fax:
Practice Address - Street 1:4040 N MARTIN L KING BLVD STE A
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-3205
Practice Address - Country:US
Practice Address - Phone:702-644-4673
Practice Address - Fax:702-902-5443
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily