Provider Demographics
NPI:1972001212
Name:PHILLIPS, SARA FRANCES (RN, BSN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:FRANCES
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:FRANCES
Other - Last Name:BRYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:1075 S BRANNON STAND RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-7359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1075 S BRANNON STAND RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-7359
Practice Address - Country:US
Practice Address - Phone:334-340-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-104792163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse