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General NPI Number Information
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NPI Number | 1174344998
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Entity Type | Individual
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Provider Name | ANTERRICA GWENA' MYLES
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Gender | Female
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 1800 BUCKNER ST STE A206
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City | SHREVEPORT
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State | LA
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Zip | 71101-4438
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Country | US
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Telephone | 318-678-8801
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Fax |
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Provider Business Mailing Address
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Address Line | 1088 FRONTAGE RD
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City | MINDEN
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State | LA
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Zip | 71055-7861
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Country | US
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Telephone | 318-588-2147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 237401
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 237401
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License Number State | LA
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