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NPI Code Detail

MEDICARE: AIRNEIDA BUMGARDNER-MILES

MEDICARE: AIRNEIDA BUMGARDNER-MILES
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
1156FX1800XOptician111731KY

General Provider Information

NPI Number : 1639879455
Entity Type Code : Individual
Provider Name (Legal Business Name) : AIRNEIDA BUMGARDNER-MILES
Provider Business Mailing Address
First Line : 14800 FORT CAMPBELL BLVD
Second Line :
City : OAK GROVE
State : KY
Zip : 42262-8304
Country : US
Telephone Number : 270-640-4828
Fax Number :
Provider Business Practice Location Address
First Line : 14800 FORT CAMPBELL BLVD
Second Line :
City : OAK GROVE
State : KY
Zip : 42262-8304
Country : US
Telephone Number : 270-640-4828
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2023
Last Update Date : 03/09/2023

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Directions to “ AIRNEIDA BUMGARDNER-MILES ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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