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General NPI Number Information
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NPI Number | 1073525903
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Entity Type | Individual
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Provider Name | MAURICE SKILLERN DMS-PA
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 4131 KIRBY PKWY STE 1
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City | MEMPHIS
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State | TN
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Zip | 38115-6500
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Country | US
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Telephone | 706-536-3272
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Fax | 833-903-2341
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Provider Business Mailing Address
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Address Line | 4131 KIRBY PKWY STE 1 KIRBY-RAINES MEDICAL CENTER
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City | MEMPHIS
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State | TN
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Zip | 38115
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Country | US
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Telephone | 901-305-6766
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Fax | 833-903-2341
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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