Provider Demographics
NPI:1063819308
Name:PHILLIPS, TAMARA KACEY (RN)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:KACEY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:KACEY
Other - Last Name:WEBBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15001 E. OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:303-693-1550
Mailing Address - Fax:303-693-5481
Practice Address - Street 1:15001 E. OXFORD AVE
Practice Address - Street 2:EXCELSIOR YOUTH CENTER
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-693-1550
Practice Address - Fax:303-693-5481
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0165225163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse