Provider Demographics
NPI:1033831490
Name:DOSWELL, MIRANDA PYLES (APRN)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:PYLES
Last Name:DOSWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11539 HUEBNER RD APT 1213
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1763
Mailing Address - Country:US
Mailing Address - Phone:210-542-3018
Mailing Address - Fax:
Practice Address - Street 1:20642 STONE OAK PKWY STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7363
Practice Address - Country:US
Practice Address - Phone:210-650-0814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1093953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily