MEDICARE: DR. MICHELLE NICOLE PHILLIPS MD

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	207P00000X	Emergency Medicine Physician	25MA10164900	NJ
2	208000000X	Pediatrics Physician	E-10842	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629599287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE NICOLE PHILLIPS MD

Provider Business Mailing Address
First Line	:	PO BOX 497
Second Line	:
City	:	AUGUSTA
State	:	AR
Zip	:	72006-0497
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 E HERITAGE PKWY
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-5529
Country	:	US
Telephone Number	:	479-400-1140
Fax Number	:

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

Provider Enumeration Date	:	07/03/2017
Last Update Date	:	04/07/2025

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Directions to “ DR. MICHELLE NICOLE PHILLIPS MD” Practice Location

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