Provider Demographics
NPI:1558050419
Name:PHILLIPS, JAMIE JATERRA (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:JATERRA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 N FRAZIER ST APT 801
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77303-1795
Mailing Address - Country:US
Mailing Address - Phone:936-499-5349
Mailing Address - Fax:
Practice Address - Street 1:2213 N FRAZIER ST APT 801
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77303-1795
Practice Address - Country:US
Practice Address - Phone:936-499-5349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy