Provider Demographics
NPI:1629183082
Name:PHILLIPS, OLIVE ANN I (APN)
Entity Type:Individual
Prefix:MRS
First Name:OLIVE
Middle Name:ANN
Last Name:PHILLIPS
Suffix:I
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 VALLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2789
Mailing Address - Country:US
Mailing Address - Phone:501-223-3427
Mailing Address - Fax:
Practice Address - Street 1:1400 FORT ROOTS DR.
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114
Practice Address - Country:US
Practice Address - Phone:501-257-2626
Practice Address - Fax:501-257-2026
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAO1389363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARVAD000Medicare UPIN