Provider Demographics
NPI:1669894051
Name:CARLILE, MICHELLE (FNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CARLILE
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 1:5219 CITY BANK PKWY STE 35
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3545
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:806-782-0097
Practice Address - Street 1:3502 9TH ST STE 440
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3368
Practice Address - Country:US
Practice Address - Phone:067-610-5358
Practice Address - Fax:806-761-0534
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125125363LF0000X
TX728496363LF0000X
TXF0114374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342885603Medicaid
NM41159004Medicaid
TX342039102OtherFIRSTCARE
TX347304YKT8OtherMEDICARE
TX8037NXOtherBCBS