Healthcare Provider Details

I. General information

NPI: 1336569680
Provider Name (Legal Business Name): LISA PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 6TH AVE S
BIRMINGHAM AL
35233-2110
US

IV. Provider business mailing address

2000 6TH AVE S
BIRMINGHAM AL
35233-2110
US

V. Phone/Fax

Practice location:
  • Phone: 205-801-8000
  • Fax:
Mailing address:
  • Phone: 205-801-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-100108
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1169164
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: