1578368692 NPI number — TARA ASHLEY MICHELLE MILES RN

Table of content: TARA ASHLEY MICHELLE MILES RN (NPI 1578368692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578368692 NPI number — TARA ASHLEY MICHELLE MILES RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILES
Provider First Name:
TARA ASHLEY
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FELTON
Provider Other First Name:
TARA ASHLEY
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578368692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
KANSAS CITY VA
Provider Second Line Business Mailing Address:
4801 LINWOOD BLVD
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-861-4700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KANSAS CITY VA
Provider Second Line Business Practice Location Address:
4801 LINWOOD BLVD
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-861-4700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  R0122071 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)