Provider Demographics
NPI:1306391297
Name:LOUDERMILK, ANOLYNN (NP-C)
Entity Type:Individual
Prefix:
First Name:ANOLYNN
Middle Name:
Last Name:LOUDERMILK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 FERN DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-6617
Mailing Address - Country:US
Mailing Address - Phone:682-219-7075
Mailing Address - Fax:
Practice Address - Street 1:294 UPTOWN BLVD STE 120
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3537
Practice Address - Country:US
Practice Address - Phone:972-293-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-20
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily