Provider Demographics
NPI:1225405590
Name:SCHILLING, AUDREY CORINNE (MSM FNP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:CORINNE
Last Name:SCHILLING
Suffix:
Gender:F
Credentials:MSM FNP
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:CORINNE
Other - Last Name:BOGGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN RN
Mailing Address - Street 1:302 GREENSBORO ST
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2802
Mailing Address - Country:US
Mailing Address - Phone:901-461-4161
Mailing Address - Fax:
Practice Address - Street 1:107 BRANDON RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2521
Practice Address - Country:US
Practice Address - Phone:662-324-1291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA810708363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner