Healthcare Provider Details

I. General information

NPI: 1477370609
Provider Name (Legal Business Name): NEYSA MILES-WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 RIVER CREST DR
LOUISVILLE KY
40206-3207
US

IV. Provider business mailing address

810 RIVER CREST DR
LOUISVILLE KY
40206-3207
US

V. Phone/Fax

Practice location:
  • Phone: 706-714-0005
  • Fax:
Mailing address:
  • Phone: 706-714-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number50254954
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: