Healthcare Provider Details

I. General information

NPI: 1245486745
Provider Name (Legal Business Name): NATHAN JARVIS MILES PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4169 BOONE CREEK RD
LEXINGTON KY
40509-9712
US

IV. Provider business mailing address

4169 BOONE CREEK RD
LEXINGTON KY
40509-9712
US

V. Phone/Fax

Practice location:
  • Phone: 859-379-9721
  • Fax: 859-813-9244
Mailing address:
  • Phone: 859-940-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number129918
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number129918
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number129918
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number129918
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: