Provider Demographics
NPI:1689487548
Name:WARD, MYLA DEANDRA (DNP, PNP)
Entity type:Individual
Prefix:DR
First Name:MYLA
Middle Name:DEANDRA
Last Name:WARD
Suffix:
Gender:F
Credentials:DNP, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 HIDDEN CELLARS DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-8515
Mailing Address - Country:US
Mailing Address - Phone:843-860-2835
Mailing Address - Fax:
Practice Address - Street 1:604 AVENT FERRY RD
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-8928
Practice Address - Country:US
Practice Address - Phone:919-586-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021563363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics