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General NPI Number Information
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NPI Number | 1558921296
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Entity Type | Individual
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Provider Name | COURTNEY LEANE MILES PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/14/2019
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 1420 US HIGHWAY 61
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City | FESTUS
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State | MO
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Zip | 63028-4108
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Country | US
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Telephone | 636-543-2230
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Fax |
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Provider Business Mailing Address
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Address Line | 2109 PROVIDENCE PARK LN
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City | HERCULANEUM
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State | MO
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Zip | 63048-1721
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Country | US
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Telephone | 314-223-6690
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2021033085
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 2013016420
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License Number State | MO
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