Provider Demographics
NPI:1114576592
Name:PHILLIPS, ELIZABETH YOLANDA (FNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:YOLANDA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6177 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-3123
Mailing Address - Country:US
Mailing Address - Phone:901-487-7944
Mailing Address - Fax:
Practice Address - Street 1:7645 WOLF RIVER CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1751
Practice Address - Country:US
Practice Address - Phone:901-869-2929
Practice Address - Fax:901-922-6845
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903418363LF0000X
TN26350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily