Provider Demographics
NPI:1316781115
Name:PALOMO, MAYLA DAWN (APRN, FNP-BC, NP-C)
Entity type:Individual
Prefix:DR
First Name:MAYLA
Middle Name:DAWN
Last Name:PALOMO
Suffix:
Gender:F
Credentials:APRN, FNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PRUDDY OAKS
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-3850
Mailing Address - Country:US
Mailing Address - Phone:360-314-8649
Mailing Address - Fax:
Practice Address - Street 1:13140 W STATE HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-6284
Practice Address - Country:US
Practice Address - Phone:360-314-8649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX933621163WE0003X
TX1176752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency