Provider Demographics
NPI:1194821223
Name:PHILLIPS, LINDA SUE (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 FINCH RD
Mailing Address - Street 2:PARKER-RACOR HEALTHSTAT CLINIC
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-4125
Mailing Address - Country:US
Mailing Address - Phone:209-575-7481
Mailing Address - Fax:209-575-7440
Practice Address - Street 1:3400 FINCH RD
Practice Address - Street 2:PARKER-RACOR HEALTHSTAT CLINIC
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-4125
Practice Address - Country:US
Practice Address - Phone:209-575-7481
Practice Address - Fax:209-575-7440
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 14856363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ48224ZMedicare PIN