Provider Demographics
NPI:1821545104
Name:ST JONN, MYLES (FNP)
Entity Type:Individual
Prefix:
First Name:MYLES
Middle Name:
Last Name:ST JONN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E MENDENHALL ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3638
Mailing Address - Country:US
Mailing Address - Phone:406-585-1360
Mailing Address - Fax:
Practice Address - Street 1:214 E MENDENHALL ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3638
Practice Address - Country:US
Practice Address - Phone:406-585-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAPRN-104589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily