Provider Demographics
NPI:1376622316
Name:BROWN-PHILLIPS, CONSTANCE LASANDRA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:LASANDRA
Last Name:BROWN-PHILLIPS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:CONSTANCE
Other - Middle Name:LASANDRA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:315 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-2203
Mailing Address - Country:US
Mailing Address - Phone:918-582-9355
Mailing Address - Fax:918-594-4889
Practice Address - Street 1:5051 S 129TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-7004
Practice Address - Country:US
Practice Address - Phone:918-582-9355
Practice Address - Fax:918-594-4889
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0074557363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner