Healthcare Provider Details

I. General information

NPI: 1003244047
Provider Name (Legal Business Name): CARROLL L PHILLIPS DNP, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2013
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HIDDEN VALLEY RD
MC MURRAY PA
15317-2685
US

IV. Provider business mailing address

129 BROOKDALE CIR
MC MURRAY PA
15317-3357
US

V. Phone/Fax

Practice location:
  • Phone: 724-655-6531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG0813036
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP013351
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierAG0813036
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAANP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: