MEDICARE: MRS. PHYLLIS B FOX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach	A-3463990

General Provider Information

NPI Number	:	1124849542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PHYLLIS B FOX

Provider Business Mailing Address
First Line	:	3305 VICTORIA CT
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2201
Country	:	US
Telephone Number	:	423-502-4150
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 VICTORIA CT
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2201
Country	:	US
Telephone Number	:	423-502-4150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2024
Last Update Date	:	10/18/2024

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