Provider Demographics
NPI:1376153825
Name:MYLES, KATE PRIYA (NP)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:PRIYA
Last Name:MYLES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 DEVONSHIRE DR.
Mailing Address - Street 2:BLDG C, SUITE 144
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820
Mailing Address - Country:US
Mailing Address - Phone:765-560-3864
Mailing Address - Fax:
Practice Address - Street 1:701 DEVONSHIRE DR.
Practice Address - Street 2:BLDG C, SUITE 144
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820
Practice Address - Country:US
Practice Address - Phone:765-560-3864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-08
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021704363LF0000X
IL209.021704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily