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General NPI Number Information
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NPI Number | 1720406291
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Entity Type | Individual
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Provider Name | NICHOLAS PHILLIPS MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 302 5TH ST STE 3
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City | CLARKSTON
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State | WA
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Zip | 99403-1803
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Country | US
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Telephone | 509-769-2211
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Fax | 509-769-2210
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Provider Business Mailing Address
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Address Line | 1922 POWERS DR
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City | LEWISTON
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State | ID
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Zip | 83501-6043
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Country | US
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Telephone | 208-305-0467
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 10344697-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 10344697-1205
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License Number State | UT
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