Provider Demographics
NPI:1376257642
Name:PHILLIPS, LAMEISHA MARQUITA (PRSS, CM1,)
Entity Type:Individual
Prefix:
First Name:LAMEISHA
Middle Name:MARQUITA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PRSS, CM1,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16603 US HIGHWAY 271
Mailing Address - Street 2:
Mailing Address - City:SPIRO
Mailing Address - State:OK
Mailing Address - Zip Code:74959-5284
Mailing Address - Country:US
Mailing Address - Phone:918-564-5628
Mailing Address - Fax:
Practice Address - Street 1:15949 US HIGHWAY 271
Practice Address - Street 2:
Practice Address - City:SPIRO
Practice Address - State:OK
Practice Address - Zip Code:74959-5276
Practice Address - Country:US
Practice Address - Phone:918-839-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty