Healthcare Provider Details

I. General information

NPI: 1922302330
Provider Name (Legal Business Name): LAUREN L MIES CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 RURAL ACRES DR
BECKLEY WV
25801-3503
US

IV. Provider business mailing address

220 CAMPUS BLVD
WINCHESTER VA
22601-2888
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-8324
  • Fax:
Mailing address:
  • Phone: 540-536-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number79348
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: