Provider Demographics
NPI:1720440761
Name:MILES, ANDREA LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEE
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 1:1159 BEECH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:COAL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47427-7900
Mailing Address - Country:US
Mailing Address - Phone:812-219-5702
Mailing Address - Fax:
Practice Address - Street 1:1159 BEECH CHURCH RD
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:IN
Practice Address - Zip Code:47427-7900
Practice Address - Country:US
Practice Address - Phone:812-219-5702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28184825A163W00000X
CA95351829163W00000X
HIRN-114808-0163W00000X
NY903785-01163W00000X
MI4704407578163W00000X, 363LF0000X
HIAPRN-4255-0363L00000X
TX1137353363LF0000X
MDAC005667363LF0000X
OHAPRN.CNP.0034958363LF0000X
KY4007286363LF0000X
CO0100902363LF0000X
KS53-82432-041363LF0000X
UT13499833-4405363LF0000X
IN71006184A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner