Healthcare Provider Details

I. General information

NPI: 1093636094
Provider Name (Legal Business Name): TRACY L MILES BSN,RN,CMSRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 GATEWAY BLVD
NEWBURGH IN
47630-8947
US

IV. Provider business mailing address

1944 LONG LAKE DR
BOONVILLE IN
47601-8084
US

V. Phone/Fax

Practice location:
  • Phone: 812-842-3962
  • Fax:
Mailing address:
  • Phone: 812-842-3962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28259711A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License Number28259711A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number28259711A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: