Provider Demographics
NPI:1992849509
Name:ATKINSON, PHYLLIS J (NP)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:J
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-1060
Mailing Address - Country:US
Mailing Address - Phone:513-275-6551
Mailing Address - Fax:513-275-6557
Practice Address - Street 1:954 SEDGEFIELD CT
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-7513
Practice Address - Country:US
Practice Address - Phone:513-275-6551
Practice Address - Fax:513-275-6557
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02537363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2939477Medicaid
OH2939477Medicaid
S74274Medicare UPIN