Healthcare Provider Details

I. General information

NPI: 1972659381
Provider Name (Legal Business Name): SANDRA LYNN MILES CNA, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1362 N GATEWAY AVE
ROCKWOOD TN
37854-4108
US

IV. Provider business mailing address

1362 N GATEWAY AVE
ROCKWOOD TN
37854-4108
US

V. Phone/Fax

Practice location:
  • Phone: 865-354-1220
  • Fax: 865-354-0112
Mailing address:
  • Phone: 865-354-1220
  • Fax: 865-354-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: