Basic Information
| Provider Information | |||||||||
| NPI: | 1912409053 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCPHILLIPS | ||||||||
| FirstName: | MARCIE | ||||||||
| MiddleName: | BANKSTON | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5120 LODS FIELD RD | ||||||||
| Address2: | |||||||||
| City: | GRAND BAY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365413100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513774559 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3719 DAUPHIN ST | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366081753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513449630 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2018 | ||||||||
| LastUpdateDate: | 03/05/2018 | ||||||||
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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 | 1-136202 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1-136202 | 01 | AL | HEALTH INSURANCE | OTHER | 1-136202 | 05 | AL | MEDICAID |