Provider Demographics
NPI:1205417987
Name:MYERS, AUDRA LEA (FNP, IBCLC)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:LEA
Last Name:MYERS
Suffix:
Gender:F
Credentials:FNP, IBCLC
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:L
Other - Last Name:STILLWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4625 ARCHER DR
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-3314
Mailing Address - Country:US
Mailing Address - Phone:214-477-0854
Mailing Address - Fax:
Practice Address - Street 1:4625 ARCHER DR
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-3314
Practice Address - Country:US
Practice Address - Phone:214-477-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF02211165207Q00000X
TX1035264363LF0000X
TXL-25811163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant