MEDICARE: MISS KIMBLYN LASHUN GILYARD RN, LMT,MMP

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	163W00000X	Registered Nurse	582524	TX
2	163WM1400X	Nurse Massage Therapist (NMT)	MT040302	TX
3	174400000X	Specialist	MT040302	TX
4	163WH0200X	Home Health Registered Nurse	582524	TX
5	163WH1000X	Hospice Registered Nurse	582524	TX
6	163WW0000X	Wound Care Registered Nurse	582524	TX
7	163WC1500X	Community Health Registered Nurse	582524	TX
8	163WP0000X	Pain Management Registered Nurse	582524	TX
9	163WS0121X	Plastic Surgery Registered Nurse	582524	TX

General Provider Information

NPI Number	:	1639363104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KIMBLYN LASHUN GILYARD RN, LMT,MMP

Provider Business Mailing Address
First Line	:	7410 BLANCO RD
Second Line	:	STE 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4363
Country	:	US
Telephone Number	:	210-861-7828
Fax Number	:

Provider Business Practice Location Address
First Line	:	7410 BLANCO RD
Second Line	:	STE 104
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4363
Country	:	US
Telephone Number	:	210-861-7828
Fax Number	:

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

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	10/16/2013

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