1619281615 NPI number — DARAKA YAKIMA MILES APRN

Table of content: MS. LORRAINE MATHES BSLBSW (NPI 1003057472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619281615 NPI number — DARAKA YAKIMA MILES APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILES
Provider First Name:
DARAKA
Provider Middle Name:
YAKIMA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619281615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2335 CHURCH ST STE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZACHARY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70791-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-654-3607
Provider Business Mailing Address Fax Number:
225-658-2262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19900 OLD SCENIC HWY
Provider Second Line Business Practice Location Address:
STE H
Provider Business Practice Location Address City Name:
ZACHARY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70791-7368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-642-9676
Provider Business Practice Location Address Fax Number:
225-642-9696
Provider Enumeration Date:
08/02/2010

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: 363LF0000X , with the licence number:  AP06229 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2117751 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AP06229 . This is a "LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com