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General NPI Number Information
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NPI Number | 1578890752
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Entity Type | Individual
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Provider Name | TRACI MARLENA PHILLIPS BSN,RN,MSN,FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 723 9TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25701-2718
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Country | US
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Telephone | 45-290-6453
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Fax | 304-529-3026
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Provider Business Mailing Address
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Address Line | PO BOX 1680
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City | HUNTINGTON
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State | WV
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Zip | 25717-1680
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Country | US
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Telephone | 304-528-6445
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Fax | 304-528-5220
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 66503
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License Number State | WV
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