Healthcare Provider Details

I. General information

NPI: 1932105152
Provider Name (Legal Business Name): BRIAN JAY PHILLIPS MSN, APRN, BC, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 CLARKSVILLE ST
PARIS TX
75460-6245
US

IV. Provider business mailing address

2131 CLARKSVILLE ST
PARIS TX
75460-6245
US

V. Phone/Fax

Practice location:
  • Phone: 903-784-8900
  • Fax: 903-784-8953
Mailing address:
  • Phone: 903-784-8900
  • Fax: 903-784-8953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number645797
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: