Provider Demographics
NPI:1689008617
Name:MILES, CYNTHIA A (RN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:MILES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:A
Other - Last Name:LEEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:900 E LAHARPE ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-4520
Mailing Address - Country:US
Mailing Address - Phone:660-665-1962
Mailing Address - Fax:660-665-3989
Practice Address - Street 1:5620 W. WILDWOOD PARKWAY
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-623-1990
Practice Address - Fax:417-623-9931
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO140953163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse