Healthcare Provider Details

I. General information

NPI: 1033769260
Provider Name (Legal Business Name): ELIZABETH ROSE PHILLIPS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 CENTRAL AVE #3349
EIELSON AFB AK
99702-2301
US

IV. Provider business mailing address

4800 CENTRAL AVE #3349
EIELSON AFB AK
99702-3101
US

V. Phone/Fax

Practice location:
  • Phone: 907-377-1847
  • Fax:
Mailing address:
  • Phone: 907-377-3071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberN361190153
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: