Healthcare Provider Details

I. General information

NPI: 1194228833
Provider Name (Legal Business Name): SEBRINA PHILLIPS RN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 07/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HOSPITAL AVE STE 5
JEFFERSON NC
28640
US

IV. Provider business mailing address

280 FANNIE COVE EXT
WARRENSVILLE NC
28693-9293
US

V. Phone/Fax

Practice location:
  • Phone: 336-846-7779
  • Fax: 336-846-8370
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number139154
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5010714
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: