Provider Demographics
NPI:1023691847
Name:MYLES, ALICIA SHERRAY
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:SHERRAY
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 1:1660 KATY GAP RD APT 34105
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7733
Mailing Address - Country:US
Mailing Address - Phone:313-319-2010
Mailing Address - Fax:
Practice Address - Street 1:22003 WHITFORD CT
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7410
Practice Address - Country:US
Practice Address - Phone:832-757-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1012293363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner