Provider Demographics
NPI:1811602469
Name:MILES, KIMBERLY ROCHELLE (CRNP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ROCHELLE
Last Name:MILES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EAST CENTRAL MENTAL HEALTH
Mailing Address - Street 2:200 CHERRY STREET
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081
Mailing Address - Country:US
Mailing Address - Phone:334-566-6022
Mailing Address - Fax:
Practice Address - Street 1:EAST CENTRAL MENTAL HEALTH
Practice Address - Street 2:200 CHERRY STREET
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081
Practice Address - Country:US
Practice Address - Phone:334-566-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-137152363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health