Provider Demographics
NPI:1932701844
Name:PHILIP, AJI S (BS, RN, APRN)
Entity Type:Individual
Prefix:MS
First Name:AJI
Middle Name:S
Last Name:PHILIP
Suffix:
Gender:F
Credentials:BS, RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 S FM 51
Mailing Address - Street 2:SUITE 400, #130
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234
Mailing Address - Country:US
Mailing Address - Phone:940-626-1848
Mailing Address - Fax:940-626-1849
Practice Address - Street 1:2000 S FM 51
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3702
Practice Address - Country:US
Practice Address - Phone:940-626-1848
Practice Address - Fax:940-626-1849
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-15
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1050559363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TXPENDINGOtherBCBS