Provider Demographics
NPI:1629579578
Name:PHILLIPS-FEARIS, CHRISTIE LYNN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:LYNN
Last Name:PHILLIPS-FEARIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 S COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-9080
Mailing Address - Country:US
Mailing Address - Phone:912-826-8860
Mailing Address - Fax:912-826-2813
Practice Address - Street 1:423 S COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9080
Practice Address - Country:US
Practice Address - Phone:912-826-8860
Practice Address - Fax:912-826-2813
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN308281208800000X
KY3012071363LF0000X
GAF01181389363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3012071OtherAPRN LICENSE