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General NPI Number Information
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NPI Number | 1801378641
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Entity Type | Individual
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Provider Name | TARA LADAWN PHILLIPS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/29/2018
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 4701 W 7TH ST
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City | WAKE VILLAGE
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State | TX
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Zip | 75501-6255
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Country | US
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Telephone | 903-831-4065
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Fax | 903-831-4075
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Provider Business Mailing Address
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Address Line | 3515 RICHMOND RD
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City | TEXARKANA
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State | TX
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Zip | 75503-0711
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Country | US
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Telephone | 903-791-9355
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Fax | 903-793-0496
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1052397
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 225755
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R0113302
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License Number State | OK
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