Provider Demographics
NPI:1740788595
Name:PHILLIPS, CHANCE LEROY (NP-C)
Entity Type:Individual
Prefix:
First Name:CHANCE
Middle Name:LEROY
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 E 39TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-8209
Mailing Address - Country:US
Mailing Address - Phone:806-886-0062
Mailing Address - Fax:
Practice Address - Street 1:4564 S HARVARD AVE STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2918
Practice Address - Country:US
Practice Address - Phone:918-508-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK115935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily