Provider Demographics
NPI:1700930351
Name:SAVAGE, PHYLLIS E (FNP)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:E
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:PHYLLIS
Other - Middle Name:
Other - Last Name:SAVAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:4480 WESTMONT RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-5646
Mailing Address - Country:US
Mailing Address - Phone:901-416-8025
Mailing Address - Fax:901-416-8029
Practice Address - Street 1:4480 WESTMONT RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-5646
Practice Address - Country:US
Practice Address - Phone:901-416-8025
Practice Address - Fax:901-416-8029
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN5862363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440187Medicaid