Basic Information
| Provider Information | |||||||||
| NPI: | 1821247594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 947 SCOTLAND DR STE 107 | ||||||||
| Address2: | |||||||||
| City: | DESOTO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751152095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727093415 | ||||||||
| FaxNumber: | 2143451452 | ||||||||
| Practice Location | |||||||||
| Address1: | 947 SCOTLAND DR STE 107 | ||||||||
| Address2: | |||||||||
| City: | DESOTO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751152095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727093415 | ||||||||
| FaxNumber: | 9727093472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2008 | ||||||||
| LastUpdateDate: | 09/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 240085 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.