Provider Demographics
NPI:1740778547
Name:PHILLIPS, JAMES D (AGACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LEDGEMONT TER
Mailing Address - Street 2:
Mailing Address - City:NORTH SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-2946
Mailing Address - Country:US
Mailing Address - Phone:401-241-7265
Mailing Address - Fax:
Practice Address - Street 1:41 SANDERSON RD STE 201
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2603
Practice Address - Country:US
Practice Address - Phone:401-949-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01783363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner