Healthcare Provider Details

I. General information

NPI: 1700555810
Provider Name (Legal Business Name): DAVID JOHN PHILLIPS FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E JACKSON ST
MUNCIE IN
47303
US

IV. Provider business mailing address

625 S COUNTY ROAD 775 W
YORKTOWN IN
47396-9438
US

V. Phone/Fax

Practice location:
  • Phone: 765-468-6337
  • Fax: 765-896-8186
Mailing address:
  • Phone: 765-744-3614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28133743A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: