MEDICARE: HOLLY NICOLE MYLES N.P.

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	363L00000X	Nurse Practitioner	71002110A	IN
2	363LA2100X	Acute Care Nurse Practitioner	71002110A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000668422	OTHER	IN	ANTHEM PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922037811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY NICOLE MYLES N.P.

Provider Business Mailing Address
First Line	:	2401 RANCH RD
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-9789
Country	:	US
Telephone Number	:	765-412-4478
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 RANCH RD
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-9789
Country	:	US
Telephone Number	:	765-412-4478
Fax Number	:

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	12/15/2025

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Directions to “ HOLLY NICOLE MYLES N.P.” Practice Location

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