Provider Demographics
NPI:1700654993
Name:PHILLIPS, KARINA JASMIN
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:JASMIN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARINA
Other - Middle Name:
Other - Last Name:PERLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 N HADLEY RD
Mailing Address - Street 2:
Mailing Address - City:GODLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76044
Mailing Address - Country:US
Mailing Address - Phone:682-226-3058
Mailing Address - Fax:
Practice Address - Street 1:101 N HADLEY RD
Practice Address - Street 2:
Practice Address - City:GODLEY
Practice Address - State:TX
Practice Address - Zip Code:76044
Practice Address - Country:US
Practice Address - Phone:682-226-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1075138163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation