Provider Demographics
NPI:1396814208
Name:PHU, JIMMY THI (RNFA)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:THI
Last Name:PHU
Suffix:
Gender:M
Credentials:RNFA
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 1232
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244-1232
Mailing Address - Country:US
Mailing Address - Phone:817-988-8518
Mailing Address - Fax:817-753-6171
Practice Address - Street 1:228 TIPPERARY DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2536
Practice Address - Country:US
Practice Address - Phone:817-988-8518
Practice Address - Fax:817-753-6171
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX664284163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant