Healthcare Provider Details

I. General information

NPI: 1558921296
Provider Name (Legal Business Name): COURTNEY LEANE MILES PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 US HIGHWAY 61
FESTUS MO
63028-4108
US

IV. Provider business mailing address

2109 PROVIDENCE PARK LN
HERCULANEUM MO
63048-1721
US

V. Phone/Fax

Practice location:
  • Phone: 636-543-2230
  • Fax:
Mailing address:
  • Phone: 314-223-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2021033085
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2013016420
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: