Provider Demographics
NPI:1114414950
Name:MAYES, EVA LUCILLE
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:LUCILLE
Last Name:MAYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 W I 40 STE 110
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2518
Mailing Address - Country:US
Mailing Address - Phone:806-353-2700
Mailing Address - Fax:
Practice Address - Street 1:14390 S WESTERN ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79118-3242
Practice Address - Country:US
Practice Address - Phone:806-622-1306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330292164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse