Provider Demographics
NPI:1245532084
Name:PHILLIPS, SUZANNE NICOLE (RN, NP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:NICOLE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:GOLDTHWAITE
Mailing Address - State:TX
Mailing Address - Zip Code:76844-0152
Mailing Address - Country:US
Mailing Address - Phone:325-451-4134
Mailing Address - Fax:
Practice Address - Street 1:3800 S W S YOUNG DR STE 402
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3374
Practice Address - Country:US
Practice Address - Phone:254-618-4920
Practice Address - Fax:254-633-2297
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX685936363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner