Healthcare Provider Details

I. General information

NPI: 1003775883
Provider Name (Legal Business Name): COURTNEY LYNN MILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/19/2026
Certification Date: 01/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 HIGHWAY 30 E
BOONEVILLE MS
38829-7970
US

IV. Provider business mailing address

1081 HIGHWAY 30 E
BOONEVILLE MS
38829-7970
US

V. Phone/Fax

Practice location:
  • Phone: 662-416-9571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903340
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: