Healthcare Provider Details

I. General information

NPI: 1417946807
Provider Name (Legal Business Name): MARILYN NOBLE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVE
LUBBOCK TX
79415-3364
US

IV. Provider business mailing address

PO BOX 5865
LUBBOCK TX
79408-5865
US

V. Phone/Fax

Practice location:
  • Phone: 806-775-8600
  • Fax: 806-743-3148
Mailing address:
  • Phone: 806-743-2898
  • Fax: 806-743-2787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00772
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00772
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: