MEDICARE: MRS. JACQUELINE GOLDSMITH PHILLIPS APN

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	AO3121ANP	AR

General Provider Information

NPI Number	:	1356502710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE GOLDSMITH PHILLIPS APN

Provider Business Mailing Address
First Line	:	613 LEXINGTON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4736
Country	:	US
Telephone Number	:	479-242-9797
Fax Number	:	479-242-9751

Provider Business Practice Location Address
First Line	:	613 LEXINGTON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4736
Country	:	US
Telephone Number	:	479-242-9797
Fax Number	:	479-242-9751

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

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	11/30/2023

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