Healthcare Provider Details

I. General information

NPI: 1467908533
Provider Name (Legal Business Name): MONICA PHILLIPS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 03/23/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 20TH ST N STE 2200
BIRMINGHAM AL
35203-3261
US

IV. Provider business mailing address

1614 HARTWIG LN SW
CULLMAN AL
35055-1205
US

V. Phone/Fax

Practice location:
  • Phone: 866-949-0108
  • Fax:
Mailing address:
  • Phone: 256-507-4216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-126515
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-126515
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-126515
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: