Provider Demographics
NPI:1083783674
Name:MILES, ANN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:MILES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 65 BOX 102
Mailing Address - Street 2:99 TOIAYBE RD - KINGSTON
Mailing Address - City:AUSTIN
Mailing Address - State:NV
Mailing Address - Zip Code:89310
Mailing Address - Country:US
Mailing Address - Phone:775-964-1232
Mailing Address - Fax:775-964-1238
Practice Address - Street 1:99 TOIAYBE RD - KINGSTON
Practice Address - Street 2:HC 65 BOX 102
Practice Address - City:AUSTIN
Practice Address - State:NV
Practice Address - Zip Code:89310
Practice Address - Country:US
Practice Address - Phone:775-964-1232
Practice Address - Fax:775-964-1238
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA 680363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV104626Medicare PIN
NVP35391Medicare UPIN