Provider Demographics
NPI:1659556876
Name:PLATT, PHILLIP LELAND (BSN, RNC, NNP-BC)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:LELAND
Last Name:PLATT
Suffix:
Gender:M
Credentials:BSN, RNC, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31374
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79120-1374
Mailing Address - Country:US
Mailing Address - Phone:806-212-5303
Mailing Address - Fax:806-212-5311
Practice Address - Street 1:1600 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1799
Practice Address - Country:US
Practice Address - Phone:806-212-5303
Practice Address - Fax:806-212-5311
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX541249363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157924501Medicaid