Provider Demographics
NPI:1619749330
Name:PHILLIPS, MIRANDA SHEA (APRN-CNP, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:SHEA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:APRN-CNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 OFFICE PARK DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-7536
Mailing Address - Country:US
Mailing Address - Phone:501-847-2835
Mailing Address - Fax:
Practice Address - Street 1:408 OFFICE PARK DR STE 3
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7536
Practice Address - Country:US
Practice Address - Phone:501-847-2835
Practice Address - Fax:501-847-3802
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR226288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily