Provider Demographics
NPI:1295043800
Name:MYLES, FREDERICK JR
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:MYLES
Suffix:JR
Gender:M
Credentials:
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 4696
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-0696
Mailing Address - Country:US
Mailing Address - Phone:252-206-1112
Mailing Address - Fax:252-206-1112
Practice Address - Street 1:210 NASH ST S
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3885
Practice Address - Country:US
Practice Address - Phone:252-206-1112
Practice Address - Fax:252-206-1112
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No253Z00000XAgenciesIn Home Supportive Care