Provider Demographics
NPI:1578276267
Name:MILES, KIM YVETTE (MSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:YVETTE
Last Name:MILES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7055 TULLIS DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-2273
Mailing Address - Country:US
Mailing Address - Phone:504-287-9429
Mailing Address - Fax:
Practice Address - Street 1:1913 CAROLINA ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-5010
Practice Address - Country:US
Practice Address - Phone:504-287-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8175104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA8175OtherLA STATE BOARD OF SOCIAL WORKERS