Provider Demographics
NPI:1184058067
Name:PHILLIPS, REGINA A
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:A
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 PLEASANT GREEN RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75603-4342
Mailing Address - Country:US
Mailing Address - Phone:903-643-9516
Mailing Address - Fax:903-643-9340
Practice Address - Street 1:660 PLEASANT GREEN RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75603-4342
Practice Address - Country:US
Practice Address - Phone:903-643-9516
Practice Address - Fax:903-643-9340
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker