Healthcare Provider Details

I. General information

NPI: 1104207414
Provider Name (Legal Business Name): LORINDA LILES NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 N CENTRAL EXPY STE 215
DALLAS TX
75231-0929
US

IV. Provider business mailing address

9900 N CENTRAL EXPY STE 215
DALLAS TX
75231-0929
US

V. Phone/Fax

Practice location:
  • Phone: 214-396-4950
  • Fax: 877-423-5360
Mailing address:
  • Phone: 214-396-4950
  • Fax: 877-423-5360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP127308
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: