Provider Demographics
NPI:1477964153
Name:MILES, KENDRA LEANN (BHCMII)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:LEANN
Last Name:MILES
Suffix:
Gender:F
Credentials:BHCMII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-5362
Mailing Address - Country:US
Mailing Address - Phone:615-474-4429
Mailing Address - Fax:
Practice Address - Street 1:111 MEADOW LN
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5362
Practice Address - Country:US
Practice Address - Phone:615-474-4429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management