Provider Demographics
NPI:1659070431
Name:PHILLIPS, FRANJELICA
Entity Type:Individual
Prefix:
First Name:FRANJELICA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 W UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2997
Mailing Address - Country:US
Mailing Address - Phone:580-634-4053
Mailing Address - Fax:918-515-1019
Practice Address - Street 1:2701 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2997
Practice Address - Country:US
Practice Address - Phone:580-634-4053
Practice Address - Fax:918-515-1019
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK452062879Medicaid