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General NPI Number Information
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NPI Number | 1073753638
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Entity Type | Individual
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Provider Name | CARLY FERGUSON PHILLIPS PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 825 NE 10TH ST STE 1C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5417
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Country | US
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Telephone | 405-271-2663
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Fax | 405-271-3074
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Provider Business Mailing Address
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Address Line | 825 NE 10TH ST STE 1C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5417
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Country | US
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Telephone | 405-271-4426
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Fax | 405-271-6762
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-01744
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.004349RX
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4708
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License Number State | OK
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