MEDICARE: TAMEKA LENE' MYLES FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F12180661	AL

General Provider Information

NPI Number	:	1861958241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMEKA LENE' MYLES FNP-C

Provider Business Mailing Address
First Line	:	2905 EAST SOUTH BOULEVARD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116
Country	:	US
Telephone Number	:	334-288-0009
Fax Number	:

Provider Business Practice Location Address
First Line	:	2905 EAST SOUTH BOULEVARD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116
Country	:	US
Telephone Number	:	334-288-0009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2019
Last Update Date	:	06/26/2019

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