Provider Demographics
NPI:1851856025
Name:MYLES, JACQUELINE HUDSON
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:HUDSON
Last Name:MYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 HEDGEROW DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-4424
Mailing Address - Country:US
Mailing Address - Phone:901-679-1687
Mailing Address - Fax:
Practice Address - Street 1:3940 HEDGEROW DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-4424
Practice Address - Country:US
Practice Address - Phone:901-679-1687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN066238725OtherTRANSPORTATION