Individual
JILLIAN ANN MILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
908 DUPONT RD, LOUISVILLE, KY 40207
(502) 749-7909
(502) 749-9397
Mailing address
100 E LIBERTY ST STE 800, LOUISVILLE, KY 40202-1428
(502) 749-7909
(502) 749-9397
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1788
KY
363AM0700X
Medical Physician Assistant
TC161
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100227320-KOHMG
—
KY
01
—
K069982-KOHMG
KY MEDICARE
KY
01
—
P01977596-KOHMG
RR MEDICARE
KY
Enumeration date
11/01/2012
Last updated
09/06/2024
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