MEDICARE: MRS. SUMMER LYNN WILCOX CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	CP000742	SD

General Provider Information

NPI Number	:	1427307941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUMMER LYNN WILCOX CNP

Provider Business Mailing Address
First Line	:	5653 S HIGHWAY 95 STE A
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6069
Country	:	US
Telephone Number	:	928-768-2558
Fax Number	:

Provider Business Practice Location Address
First Line	:	5653 HWY 95 STE A
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6069
Country	:	US
Telephone Number	:	928-768-2558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	07/31/2023

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