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General NPI Number Information
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NPI Number | 1124849542
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Entity Type | Individual
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Provider Name | MRS. PHYLLIS B FOX
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Gender | Female
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 3305 VICTORIA CT
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2201
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Country | US
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Telephone | 423-502-4150
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 VICTORIA CT
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2201
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Country | US
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Telephone | 423-502-4150
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Fax |
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | A-3463990
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License Number State |
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