Provider Demographics
NPI:1619205069
Name:MILEY, SALLYE ANN (PNP)
Entity type:Individual
Prefix:MRS
First Name:SALLYE
Middle Name:ANN
Last Name:MILEY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MRS
Other - First Name:SALLYE
Other - Middle Name:
Other - Last Name:MILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:203 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MS
Mailing Address - Zip Code:39365-2121
Mailing Address - Country:US
Mailing Address - Phone:601-745-6244
Mailing Address - Fax:
Practice Address - Street 1:9431 EASTSIDE DRIVE EXT STE E
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MS
Practice Address - Zip Code:39345-8072
Practice Address - Country:US
Practice Address - Phone:601-635-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR869919363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics