Provider Demographics
NPI:1245532084
Name:PHILLIPS, SUZANNE NICOLE (RN, NP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:NICOLE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN, 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 152
Mailing Address - Street 2:
Mailing Address - City:GOLDTHWAITE
Mailing Address - State:TX
Mailing Address - Zip Code:76844-0152
Mailing Address - Country:US
Mailing Address - Phone:325-451-4134
Mailing Address - Fax:
Practice Address - Street 1:125 SOUTH PARK DR STE B
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5952
Practice Address - Country:US
Practice Address - Phone:325-643-5445
Practice Address - Fax:325-643-5447
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX685936363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner