Provider Demographics
NPI:1477156719
Name:PHILLIPS, PRESLEY JO (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:PRESLEY
Middle Name:JO
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:479-632-3855
Mailing Address - Fax:479-632-0356
Practice Address - Street 1:937 HIGHWAY 64 E
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-7382
Practice Address - Country:US
Practice Address - Phone:479-632-3855
Practice Address - Fax:479-632-0356
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARF11200307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily