Basic Information
| Provider Information | |||||||||
| NPI: | 1598757791 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARRON | ||||||||
| FirstName: | PHYLLIS | ||||||||
| MiddleName: | MCANELLY | ||||||||
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| Credential: | RN, APRN, FNPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4616 W HOWARD LN | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787286300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123241152 | ||||||||
| FaxNumber: | 5123243309 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 E 15TH ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787011930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123248933 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 03/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP109494 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 166465802 | 05 | TX | MEDICAID | 8N6034 | 01 | TX | BCBS | OTHER | 166465801 | 05 | TX | MEDICAID |