MEDICARE: MEREDITH COREN PHILLIPS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1094089	TX

General Provider Information

NPI Number	:	1023721305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH COREN PHILLIPS APRN

Provider Business Mailing Address
First Line	:	21707 BEAVER BEND CT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2501
Country	:	US
Telephone Number	:	704-650-5829
Fax Number	:

Provider Business Practice Location Address
First Line	:	21707 BEAVER BEND CT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2501
Country	:	US
Telephone Number	:	704-650-5829
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2023
Last Update Date	:	01/02/2023

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