MEDICARE: MRS. LILA M MOURNING ARNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	44393	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	380770	OTHER	KS	FIRSTGUARD
2	9781	OTHER	KS	PREFERRED PLUS OF KANSAS

General Provider Information

NPI Number	:	1215043492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILA M MOURNING ARNP-C

Provider Business Mailing Address
First Line	:	101 E ROSS ST
Second Line	:
City	:	CLEARWATER
State	:	KS
Zip	:	67026-7824
Country	:	US
Telephone Number	:	620-584-2055
Fax Number	:	620-584-2032

Provider Business Practice Location Address
First Line	:	101 E ROSS ST
Second Line	:
City	:	CLEARWATER
State	:	KS
Zip	:	67026-7824
Country	:	US
Telephone Number	:	620-584-2055
Fax Number	:	620-584-2032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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