Doctor Name: | SELENA PHILLIPS |
NPI Number: | 1245639327 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 19012 |
Business Practice Address: | 2727 Fairview Blvd Fairview, TN - 370629088 |
Business Phone Number: | 6157990101 |
Business Fax Number: | |
Mailing Address: | 7129 Donald Wilson Dr, FAIRVIEW |
State: | TN |
Postal Code: | 370627265 |
Phone Number: | 6153197724 |
Fax Number: | |
NPI Enumeration Date: | 08/14/2014 |
NPI Last Update Date: | 08/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 19012 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |