Provider Demographics
NPI:1043237670
Name:PHILLIPS, REGINA MORRISON (NP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MORRISON
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 888230
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-8230
Mailing Address - Country:US
Mailing Address - Phone:865-305-6333
Mailing Address - Fax:865-305-6364
Practice Address - Street 1:1932 ALCOA HWY
Practice Address - Street 2:SUITE 580
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1527
Practice Address - Country:US
Practice Address - Phone:865-305-6333
Practice Address - Fax:865-305-6364
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN000011068363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3641477Medicare PIN