Provider Demographics
NPI:1194228833
Name:PHILLIPS, SEBRINA (RN, NP-C)
Entity Type:Individual
Prefix:
First Name:SEBRINA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 FANNIE COVE EXT
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28693-9293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 HOSPITAL AVE STE 5
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640
Practice Address - Country:US
Practice Address - Phone:336-846-7779
Practice Address - Fax:336-846-8370
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC139154163W00000X
NC5010714363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse