Healthcare Provider Details

I. General information

NPI: 1215043492
Provider Name (Legal Business Name): LILA M MOURNING ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E ROSS ST
CLEARWATER KS
67026-7824
US

IV. Provider business mailing address

101 E ROSS ST
CLEARWATER KS
67026-7824
US

V. Phone/Fax

Practice location:
  • Phone: 620-584-2055
  • Fax: 620-584-2032
Mailing address:
  • Phone: 620-584-2055
  • Fax: 620-584-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44393
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: