Provider Demographics
NPI:1598968018
Name:PHILLIPS, JALENE W (JALENE PHILLIPS)
Entity Type:Individual
Prefix:MS
First Name:JALENE
Middle Name:W
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:JALENE PHILLIPS
Other - Prefix:
Other - First Name:JALENE
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARRT
Mailing Address - Street 1:229 MCGEE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114-4347
Mailing Address - Country:US
Mailing Address - Phone:817-690-6676
Mailing Address - Fax:
Practice Address - Street 1:229 MCGEE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-4347
Practice Address - Country:US
Practice Address - Phone:817-690-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging