Provider Demographics
NPI:1518573344
Name:HARTLEY, MILES A
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:A
Last Name:HARTLEY
Suffix:
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 1:9270 GLENWOOD ST STE A
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1379
Mailing Address - Country:US
Mailing Address - Phone:913-336-4199
Mailing Address - Fax:
Practice Address - Street 1:9270 GLENWOOD ST STE A
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1379
Practice Address - Country:US
Practice Address - Phone:913-336-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty