Provider Demographics
NPI:1164679304
Name:MILES, MICHON M (APRN)
Entity Type:Individual
Prefix:
First Name:MICHON
Middle Name:M
Last Name:MILES
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:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-450-6879
Mailing Address - Fax:812-858-4586
Practice Address - Street 1:1700 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-6242
Practice Address - Country:US
Practice Address - Phone:270-389-0031
Practice Address - Fax:270-389-3707
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV66400363LF0000X
IL209.007921363LF0000X
KY3011611363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062597Medicaid
ILBCBSOther10019630
IL336570Medicare Oscar/Certification
IL036062597Medicaid
ILBCBSOther10019630