Healthcare Provider Details

I. General information

NPI: 1861723207
Provider Name (Legal Business Name): ASHLEY BROOKE PHILLIPS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OPTUM CIR
EDEN PRAIRIE MN
55344-2956
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 800-561-0861
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4055
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: