Healthcare Provider Details

I. General information

NPI: 1710011325
Provider Name (Legal Business Name): MICHELE MILES PA-C,MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E QUAIL RUN RD
EMMETT ID
83617-5059
US

IV. Provider business mailing address

PO BOX 191050
BOISE ID
83719-1050
US

V. Phone/Fax

Practice location:
  • Phone: 208-365-7131
  • Fax: 208-365-4464
Mailing address:
  • Phone: 208-955-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberID PA498
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: