=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750051934
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERESE D PHILLIPS DSP SITE DIRECTOR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2021
-----------------------------------------------------
Last Update Date | 03/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3543 HIGHWAY 67 W
-----------------------------------------------------
City | HOPE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71801-8858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-703-5525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3543 HIGHWAY 67 W
-----------------------------------------------------
City | HOPE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71801-8858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-703-5525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------