Provider Demographics
NPI:1720825482
Name:MILES, JAMES EDWARD (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:MILES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 GOLD DUST DR
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-3009
Mailing Address - Country:US
Mailing Address - Phone:417-592-9304
Mailing Address - Fax:
Practice Address - Street 1:1619 K66
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-4306
Practice Address - Country:US
Practice Address - Phone:417-358-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025016993367500000X
OK223143367500000X
KS162978367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered