Provider Demographics
NPI:1548579501
Name:PHILLIPS, GINGER (CRNP)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MONROE ST
Mailing Address - Street 2:SUITE 1386
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-3735
Mailing Address - Country:US
Mailing Address - Phone:334-206-7959
Mailing Address - Fax:334-206-3998
Practice Address - Street 1:2350 HARGROVE RD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405
Practice Address - Country:US
Practice Address - Phone:205-367-8157
Practice Address - Fax:205-367-8376
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-079818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily