Provider Demographics
NPI:1992039325
Name:PHILLIPS, ANGELA K (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:K
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:KORNEGAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18TH MEDICAL GROUP
Mailing Address - Street 2:BLDG #626
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:626 VINCENT AVE
Practice Address - Street 2:18TH MEDICAL GROUP
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96367
Practice Address - Country:US
Practice Address - Phone:81098-960-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14447363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health