Provider Demographics
NPI:1619442282
Name:ACORD, MAYRA ALEJANDRA AVILA (RN, AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:ALEJANDRA AVILA
Last Name:ACORD
Suffix:
Gender:F
Credentials:RN, AGACNP-BC
Other - Prefix:
Other - First Name:MAYRA
Other - Middle Name:ALEJANDRA
Other - Last Name:AVILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4807 BARCLAY DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3131
Mailing Address - Country:US
Mailing Address - Phone:903-391-5949
Mailing Address - Fax:
Practice Address - Street 1:700 OLYMPIC PLAZA CIR STE 850
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1955
Practice Address - Country:US
Practice Address - Phone:903-595-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX829710163W00000X
TXAP139168363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse