Provider Demographics
NPI:1013956341
Name:MILAM, MARY LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:MILAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7722 WOODROW RD
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-5613
Mailing Address - Country:US
Mailing Address - Phone:806-863-2853
Mailing Address - Fax:
Practice Address - Street 1:301 40TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79404-2746
Practice Address - Country:US
Practice Address - Phone:806-743-9355
Practice Address - Fax:806-743-9363
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2019-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP108194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y3717OtherBCBS
TX9078128OtherAETNA
TX5892790001Medicare NSC
TX8Y3717OtherBCBS