Healthcare Provider Details

I. General information

NPI: 1114576592
Provider Name (Legal Business Name): ELIZABETH YOLANDA PHILLIPS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2019
Last Update Date: 09/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7645 WOLF RIVER CIR
GERMANTOWN TN
38138-1751
US

IV. Provider business mailing address

6177 SEMINOLE DR
OLIVE BRANCH MS
38654-3123
US

V. Phone/Fax

Practice location:
  • Phone: 901-869-2929
  • Fax: 901-922-6845
Mailing address:
  • Phone: 901-487-7944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number903418
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26350
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: