Provider Demographics
NPI:1598189078
Name:PHILLIPS, BETH ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9782 HIGHWAY 903
Mailing Address - Street 2:
Mailing Address - City:BRACEY
Mailing Address - State:VA
Mailing Address - Zip Code:23919-1991
Mailing Address - Country:US
Mailing Address - Phone:434-636-6903
Mailing Address - Fax:
Practice Address - Street 1:9782 HIGHWAY 903
Practice Address - Street 2:
Practice Address - City:BRACEY
Practice Address - State:VA
Practice Address - Zip Code:23919-1991
Practice Address - Country:US
Practice Address - Phone:434-636-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily