Provider Demographics
NPI:1326598194
Name:MILES, ANGELA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8850 SIX PINES DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2683
Mailing Address - Country:US
Mailing Address - Phone:281-419-2220
Mailing Address - Fax:281-419-2280
Practice Address - Street 1:8850 SIX PINES DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-2683
Practice Address - Country:US
Practice Address - Phone:281-419-2220
Practice Address - Fax:281-419-2280
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA10403363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant