Provider Demographics
NPI:1942749015
Name:MILES, HEATHER MEREE (FNP-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MEREE
Last Name:MILES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 SADDLE RDG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1558
Mailing Address - Country:US
Mailing Address - Phone:210-409-3915
Mailing Address - Fax:
Practice Address - Street 1:12602 TOEPPERWEIN RD STE 201
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3271
Practice Address - Country:US
Practice Address - Phone:210-646-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily