Provider Demographics
NPI:1245200468
Name:MILES, DEBORAH ANN I (APN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:MILES
Suffix:I
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4105
Mailing Address - Country:US
Mailing Address - Phone:870-236-4100
Mailing Address - Fax:870-236-4122
Practice Address - Street 1:2709 W KINGSHIGHWAY STE 6
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2644
Practice Address - Country:US
Practice Address - Phone:870-236-7272
Practice Address - Fax:870-236-7275
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAO1466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150835003Medicaid
AR150835003Medicaid
AR5F554Medicare PIN