MEDICARE: ANTERRICA GWENA' MYLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	237401	LA
2	363LP2300X	Primary Care Nurse Practitioner	237401	LA

General Provider Information

NPI Number	:	1174344998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTERRICA GWENA' MYLES

Provider Business Mailing Address
First Line	:	1088 FRONTAGE RD
Second Line	:
City	:	MINDEN
State	:	LA
Zip	:	71055-7861
Country	:	US
Telephone Number	:	318-588-2147
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 BUCKNER ST STE A206
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4438
Country	:	US
Telephone Number	:	318-678-8801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	06/01/2026

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Directions to “ ANTERRICA GWENA' MYLES ” Practice Location

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