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General NPI Number Information
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NPI Number | 1487294823
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Entity Type | Individual
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Provider Name | DEEDRA DENAE PHIPPS
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Gender | Female
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Dates
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Enumeration Date | 01/14/2020
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Last Update Date | 01/14/2020
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Provider Practice Location Address
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Address Line | 1223 COUNTY ROAD 4764
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City | BOYD
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State | TX
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Zip | 76023-5205
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Country | US
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Telephone | 940-210-8335
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1594
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City | BOYD
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State | TX
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Zip | 76023-1594
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Country | US
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Telephone | 940-210-8335
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 351951
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License Number State | TX
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