Provider Demographics
NPI:1508835380
Name:ADAMS, PHYLLIS
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 CHINKAPIN PL
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3229
Mailing Address - Country:US
Mailing Address - Phone:972-724-2009
Mailing Address - Fax:817-272-5006
Practice Address - Street 1:701 E ARBROOK BLVD STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3240
Practice Address - Country:US
Practice Address - Phone:682-867-1500
Practice Address - Fax:817-419-1129
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX420156363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX44385503Medicaid
TXP19411Medicare UPIN
TX44385503Medicaid