Provider Demographics
NPI:1194205922
Name:MILES, KAYLA ANNE
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:ANNE
Last Name:MILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6408
Mailing Address - Country:US
Mailing Address - Phone:817-481-2444
Mailing Address - Fax:817-421-0277
Practice Address - Street 1:550 N CARROLL AVE
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6408
Practice Address - Country:US
Practice Address - Phone:817-481-2444
Practice Address - Fax:817-421-0277
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine