Provider Demographics
NPI:1134171549
Name:MILES, JULIE S (NP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:S
Last Name:MILES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 WESTPARK WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3742
Mailing Address - Country:US
Mailing Address - Phone:682-236-3656
Mailing Address - Fax:855-813-9308
Practice Address - Street 1:251 WESTPARK WAY STE 210
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3742
Practice Address - Country:US
Practice Address - Phone:682-236-3656
Practice Address - Fax:855-813-9308
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX615398363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171262203Medicaid
TX171262204Medicaid
TX615398OtherLICENSE NUMBER
TX171262202Medicaid
TX171262205Medicaid
TX615398OtherLICENSE NUMBER
TX8B7241Medicare ID - Type Unspecified
TX171262202Medicaid
TX8L14254Medicare PIN
TXTXB122049Medicare PIN
TX8L14292Medicare PIN