Healthcare Provider Details

I. General information

NPI: 1740778547
Provider Name (Legal Business Name): JAMES D. PHILLIPS AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 DUDLEY ST
PROVIDENCE RI
02905-3236
US

IV. Provider business mailing address

2 DUDLEY ST
PROVIDENCE RI
02905-3236
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN01783
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: