Provider Demographics
NPI:1619132677
Name:PHILLIPS, TERESA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 S. UTICA AVE
Mailing Address - Street 2:STE 460
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4642
Mailing Address - Country:US
Mailing Address - Phone:918-579-5749
Mailing Address - Fax:918-560-5791
Practice Address - Street 1:1145 S. UTICA AVE
Practice Address - Street 2:STE 460
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4642
Practice Address - Country:US
Practice Address - Phone:918-579-5749
Practice Address - Fax:918-560-5791
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX530607363LF0000X
OK47205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P57294Medicare UPIN