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General NPI Number Information
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NPI Number | 1730051608
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Entity Type | Individual
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Provider Name | CANDICE T PHILLIPS DRPH
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Gender | Female
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Dates
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Enumeration Date | 09/20/2025
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Last Update Date | 09/20/2025
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Provider Practice Location Address
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Address Line | 2612 E MONROE AVE
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-6032
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Country | US
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Telephone | 901-352-8566
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Fax |
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Provider Business Mailing Address
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Address Line | 2612 E MONROE AVE
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-6032
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Country | US
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Telephone | 901-352-8566
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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 | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 105121
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number | 105121
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 908464201
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License Number State | AR
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Taxonomy #4
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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 | 2901552
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | 2657421
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License Number State | AR
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