Basic Information
| Provider Information | |||||||||
| NPI: | 1669894051 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARLILE | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5219 CITY BANK PKWY STE 35 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794073545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067610333 | ||||||||
| FaxNumber: | 8067820097 | ||||||||
| Practice Location | |||||||||
| Address1: | 3502 9TH ST STE 440 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794153368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0676105358 | ||||||||
| FaxNumber: | 8067610534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2014 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP125125 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 342885603 | 05 | TX | MEDICAID | 41159004 | 05 | NM | MEDICAID | 342039102 | 01 | TX | FIRSTCARE | OTHER | 347304YKT8 | 01 | TX | MEDICARE | OTHER | 8037NX | 01 | TX | BCBS | OTHER |