Healthcare Provider Details

I. General information

NPI: 1205926722
Provider Name (Legal Business Name): TERESA L. PHILLIPS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GARFIELD AVE CAMDEN CLARK MEMORIAL HOSPITAL
PARKERSBURG WV
26101-5340
US

IV. Provider business mailing address

13219 POND CRK RD
ROCKPORT WV
26169
US

V. Phone/Fax

Practice location:
  • Phone: 304-420-7155
  • Fax: 304-420-7139
Mailing address:
  • Phone: 304-420-7155
  • Fax: 304-420-7139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number39386
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: