Healthcare Provider Details

I. General information

NPI: 1578123402
Provider Name (Legal Business Name): CARRIE VIOLA PHILLIPS APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9478 HOMESTEAD LN.
FORNEY TX
75126
US

IV. Provider business mailing address

9478 HOMESTEAD LN.
FORNEY TX
75126
US

V. Phone/Fax

Practice location:
  • Phone: 972-743-1203
  • Fax: 972-564-0640
Mailing address:
  • Phone: 972-743-1203
  • Fax: 972-564-0640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP138600
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: