Provider Demographics
NPI:1922711480
Name:PHILLIPS, OMEGA SMITH
Entity Type:Individual
Prefix:
First Name:OMEGA
Middle Name:SMITH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15029 WALKING STICK WAY
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-3116
Mailing Address - Country:US
Mailing Address - Phone:240-675-6145
Mailing Address - Fax:
Practice Address - Street 1:315 S MCDANIEL ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:NC
Practice Address - Zip Code:27823-1727
Practice Address - Country:US
Practice Address - Phone:240-675-6145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner