Provider Demographics
NPI:1598843732
Name:WOMACK, MARILYNN (APRN,FNP-C)
Entity type:Individual
Prefix:
First Name:MARILYNN
Middle Name:
Last Name:WOMACK
Suffix:
Gender:F
Credentials:APRN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 SANDY ELM RD
Mailing Address - Street 2:
Mailing Address - City:LAVERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-4416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1025 N AUSTIN ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-4517
Practice Address - Country:US
Practice Address - Phone:830-379-1184
Practice Address - Fax:830-303-2314
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX630427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00905FMedicare ID - Type Unspecified
TXP63839Medicare UPIN