Provider Demographics
NPI:1427039502
Name:PHILLIPS, PAM B (WHNP)
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:B
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HANDLEY PARK COURT
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1769
Mailing Address - Country:US
Mailing Address - Phone:919-734-3344
Mailing Address - Fax:919-735-3025
Practice Address - Street 1:102 HANDLEY PARK COURT
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1769
Practice Address - Country:US
Practice Address - Phone:919-734-3344
Practice Address - Fax:919-735-3025
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800092363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000294Medicaid
NC7000294Medicaid