Provider Demographics
NPI:1578815106
Name:MILES, KRISTIAN D'ANN (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTIAN
Middle Name:D'ANN
Last Name:MILES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KRISTIAN
Other - Middle Name:D'ANN
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12523 LIMONITE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-3666
Mailing Address - Country:US
Mailing Address - Phone:951-808-6300
Mailing Address - Fax:
Practice Address - Street 1:12523 LIMONITE AVE STE 400
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752-3666
Practice Address - Country:US
Practice Address - Phone:951-808-6300
Practice Address - Fax:951-817-0549
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA829093163W00000X
CA95023871363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01261511Medicaid