Provider Demographics
NPI:1659704559
Name:PHILLIPS, LAURA (RN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-3409
Mailing Address - Country:US
Mailing Address - Phone:870-630-2328
Mailing Address - Fax:870-630-2348
Practice Address - Street 1:422 N SEBASTIAN
Practice Address - Street 2:
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72390-1935
Practice Address - Country:US
Practice Address - Phone:870-572-1800
Practice Address - Fax:870-572-1809
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR036262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health