Healthcare Provider Details

I. General information

NPI: 1528780335
Provider Name (Legal Business Name): HEATHER BREANNE MILES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MIAMI VALLEY DR SUITE 550
CENTERVILLE OH
45459
US

IV. Provider business mailing address

2300 MIAMI VALLEY DR SUITE 550
CENTERVILLE OH
45459
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-7500
  • Fax: 937-208-5143
Mailing address:
  • Phone: 937-438-7500
  • Fax: 937-208-5143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0039547
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0039547
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32382
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: