Provider Demographics
NPI:1275095994
Name:MILES, EMMA JEAN
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:JEAN
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 1:127 EPPLE PL
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-1939
Mailing Address - Country:US
Mailing Address - Phone:314-522-6678
Mailing Address - Fax:314-522-6681
Practice Address - Street 1:127 EPPLE PL
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-1939
Practice Address - Country:US
Practice Address - Phone:314-522-6678
Practice Address - Fax:314-522-6681
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC08407683747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1154778447Medicaid