Provider Demographics
NPI:1215043492
Name:MOURNING, LILA M (ARNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LILA
Middle Name:M
Last Name:MOURNING
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E ROSS ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:KS
Mailing Address - Zip Code:67026-7824
Mailing Address - Country:US
Mailing Address - Phone:620-584-2055
Mailing Address - Fax:620-584-2032
Practice Address - Street 1:101 E ROSS ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:KS
Practice Address - Zip Code:67026-7824
Practice Address - Country:US
Practice Address - Phone:620-584-2055
Practice Address - Fax:620-584-2032
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS380770OtherFIRSTGUARD
KS9781OtherPREFERRED PLUS OF KANSAS
KS9781OtherPREFERRED PLUS OF KANSAS
KS161440Medicare ID - Type Unspecified