Healthcare Provider Details

I. General information

NPI: 1912571613
Provider Name (Legal Business Name): CHANCE PHILLIPS, FNP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4564 S HARVARD AVE STE B
TULSA OK
74135-2918
US

IV. Provider business mailing address

2706 E 39TH PL
TULSA OK
74105-8209
US

V. Phone/Fax

Practice location:
  • Phone: 918-508-2220
  • Fax:
Mailing address:
  • Phone: 806-886-0062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHANCE LEROY PHILLIPS
Title or Position: OWNER/NURSE PRACTITIONER
Credential: APRN-CNP
Phone: 806-886-0062