Provider Demographics
NPI:1689184491
Name:PHILLIPS, VALARIE (CCM)
Entity Type:Individual
Prefix:MS
First Name:VALARIE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15911 SANDALWOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63011-5518
Mailing Address - Country:US
Mailing Address - Phone:760-270-3791
Mailing Address - Fax:
Practice Address - Street 1:292 PICKENS CIR
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-7982
Practice Address - Country:US
Practice Address - Phone:760-270-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29383163WA2000X
CA609662163WC1500X, 163WC1600X, 163WH0200X, 163WP2201X
171M00000X, 251E00000X, 347E00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251E00000XAgenciesHome Health
No347E00000XTransportation ServicesTransportation Broker