Physician Compare National (NPI:1497033740)

HEALTHCARE PROVIDER: ANGELA RENEA PHILLIPS ARNP

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1497033740
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7911173083
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150106002105
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PHILLIPS
	Individual professional last name
Provider First Name	ANGELA
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	204 E CHOCTAW AVE
	Group Practice or individual's line 1 address
City	SALLISAW
	Group Practice or individual's city
State	OK
	Group Practice or individual's state
Zip Code	749554604
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y