Healthcare Provider Details

I. General information

NPI: 1255307559
Provider Name (Legal Business Name): SHARON K MYLES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S GLOSTER ST
TUPELO MS
38801-4934
US

IV. Provider business mailing address

1065 LONE OAK RD
STEENS MS
39766-9731
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-7150
  • Fax: 662-377-2755
Mailing address:
  • Phone: 662-251-1052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR670987
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: