Provider Demographics
NPI:1821247594
Name:PHILLIPS, PAMELA KAY (PHD, FNP)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:KAY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHD, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 SCOTLAND DR STE 107
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2095
Mailing Address - Country:US
Mailing Address - Phone:972-709-3415
Mailing Address - Fax:214-345-1452
Practice Address - Street 1:947 SCOTLAND DR STE 107
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2095
Practice Address - Country:US
Practice Address - Phone:972-709-3415
Practice Address - Fax:972-709-3472
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNP0043Medicare PIN
TX553514Medicare UPIN