1013445121 NPI number — CAROLINE STEPHENS MILES PA-C, ATC, LAT

NPI Number: 1013445121
Health Care Provider/Practitioner: CAROLINE STEPHENS MILES PA-C, ATC, LAT

NPI Number : 1013445121 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1013445121",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MILES",
    "FirstName": "CAROLINE",
    "MiddleName": "STEPHENS",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C, ATC, LAT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "STEPHENS",
    "OtherFirstName": "CAROLINE",
    "OtherMiddleName": "ALICE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "ATC, LAT, NREMT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "403 STADIUM DR # D107",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TALLAHASSEE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32304-4247",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1305 JENNINGS MILL RD BLDG 300-110",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WATKINSVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30677-7238",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-613-5880",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/02/2017",
    "LastUpdateDate": "03/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}