Provider Demographics
NPI:1689831562
Name:PHILLIPS WHITE, CARMEN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:
Last Name:PHILLIPS WHITE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75065-2878
Mailing Address - Country:US
Mailing Address - Phone:940-535-5296
Mailing Address - Fax:972-535-5297
Practice Address - Street 1:503 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:LAKE DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75065-2878
Practice Address - Country:US
Practice Address - Phone:940-535-5296
Practice Address - Fax:972-535-5297
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX687867363LF0000X
TXAP116632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297136801Medicaid
TX297136803Medicaid
TX297136802Medicaid