Provider Demographics
NPI:1073525903
Name:SKILLERN, MAURICE (DMS-PA)
Entity Type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:
Last Name:SKILLERN
Suffix:
Gender:M
Credentials:DMS-PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 KIRBY PKWY STE 1
Mailing Address - Street 2:KIRBY-RAINES MEDICAL CENTER
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115
Mailing Address - Country:US
Mailing Address - Phone:901-305-6766
Mailing Address - Fax:833-903-2341
Practice Address - Street 1:4131 KIRBY PKWY STE 1
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-6500
Practice Address - Country:US
Practice Address - Phone:706-536-3272
Practice Address - Fax:833-903-2341
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ038355Medicaid