Provider Demographics
NPI:1932105152
Name:PHILLIPS, BRIAN JAY (MSN, APRN, BC, PMHNP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JAY
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MSN, APRN, BC, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 CLARKSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-6245
Mailing Address - Country:US
Mailing Address - Phone:903-784-8900
Mailing Address - Fax:903-784-8953
Practice Address - Street 1:2131 CLARKSVILLE ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-6245
Practice Address - Country:US
Practice Address - Phone:903-784-8900
Practice Address - Fax:903-784-8953
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX645797363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health