Provider Demographics
NPI:1356820773
Name:MILES, JORDAN MARIE (CNM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:MARIE
Last Name:MILES
Suffix:
Gender:F
Credentials:CNM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 HONEYSUCKLE RD STE 10
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1168
Mailing Address - Country:US
Mailing Address - Phone:850-326-6066
Mailing Address - Fax:806-482-1688
Practice Address - Street 1:256 HONEYSUCKLE RD STE 10
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1168
Practice Address - Country:US
Practice Address - Phone:850-326-6066
Practice Address - Fax:806-482-1688
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CNM05070367A00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife