Healthcare Provider Details

I. General information

NPI: 1942749015
Provider Name (Legal Business Name): HEATHER MEREE MILES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12602 TOEPPERWEIN RD STE 201
LIVE OAK TX
78233-3271
US

IV. Provider business mailing address

4702 SADDLE RDG
SAN ANTONIO TX
78217-1558
US

V. Phone/Fax

Practice location:
  • Phone: 210-646-0404
  • Fax:
Mailing address:
  • Phone: 210-409-3915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP133369
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: