Healthcare Provider Details

I. General information

NPI: 1770553844
Provider Name (Legal Business Name): MILHA KATHRYN SKELTON RN, CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 RIVER OAKS CT
TYLER TX
75707-1659
US

IV. Provider business mailing address

PO BOX 7183
TYLER TX
75711-7183
US

V. Phone/Fax

Practice location:
  • Phone: 903-566-5500
  • Fax: 903-566-7755
Mailing address:
  • Phone: 903-566-5500
  • Fax: 903-566-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number218773
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: