Basic Information
| Provider Information | |||||||||
| NPI: | 1215043492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOURNING | ||||||||
| FirstName: | LILA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E ROSS ST | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670267824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6205842055 | ||||||||
| FaxNumber: | 6205842032 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 E ROSS ST | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670267824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6205842055 | ||||||||
| FaxNumber: | 6205842032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 44393 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 380770 | 01 | KS | FIRSTGUARD | OTHER | 9781 | 01 | KS | PREFERRED PLUS OF KANSAS | OTHER |