Provider Demographics
NPI:1760095475
Name:MILES, KONYA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KONYA
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958A MCCAY AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-5177
Mailing Address - Country:US
Mailing Address - Phone:251-217-7978
Mailing Address - Fax:
Practice Address - Street 1:958A MCCAY AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5177
Practice Address - Country:US
Practice Address - Phone:251-217-7978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-138268163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty