Provider Demographics
NPI:1417459306
Name:PHILLIPS, ANGELIA MECHELLE (LVN)
Entity Type:Individual
Prefix:
First Name:ANGELIA
Middle Name:MECHELLE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 TIMBERSIDE
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75161-5374
Mailing Address - Country:US
Mailing Address - Phone:214-356-2521
Mailing Address - Fax:
Practice Address - Street 1:400 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-4302
Practice Address - Country:US
Practice Address - Phone:972-524-4159
Practice Address - Fax:972-563-3370
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189276164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse