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General NPI Number Information
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NPI Number | 1619205069
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Entity Type | Individual
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Provider Name | SALLYE ANN MILEY PNP
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Gender | Female
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 9431 EASTSIDE DRIVE EXT STE E
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City | NEWTON
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State | MS
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Zip | 39345-8072
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Country | US
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Telephone | 601-635-3435
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Fax |
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Provider Business Mailing Address
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Address Line | 203 GORDON ST
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City | UNION
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State | MS
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Zip | 39365-2121
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Country | US
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Telephone | 601-745-6244
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | R869919
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License Number State | MS
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