Provider Demographics
NPI:1184682452
Name:PHILLIPS, JAIME ANN (RN, MSN, FNP)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3200
Mailing Address - Country:US
Mailing Address - Phone:785-330-7313
Mailing Address - Fax:
Practice Address - Street 1:3421 WEST 6TH
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-330-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO146556363LF0000X
DCRN1015472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200373100AMedicaid
DC153854YT2Medicare PIN