Provider Demographics
NPI:1780374389
Name:PHILLIPS, HEATHER LATISHA (PHD, MLS(ASCP)CM)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LATISHA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHD, MLS(ASCP)CM
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LATISHA
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4756 15 GOVS LANE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37044-0001
Mailing Address - Country:US
Mailing Address - Phone:931-221-7018
Mailing Address - Fax:
Practice Address - Street 1:254 COLLEGE ST FLOOR 1
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37044-0001
Practice Address - Country:US
Practice Address - Phone:931-221-7018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246QB0000X, 246QM0900X, 246QC1000X, 246QH0000X, 246QI0000X, 246QL0900X
TN0000024390246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
No246QB0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyBlood Banking
No246QM0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMicrobiology
No246QC1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyChemistry
No246QH0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHematology
No246QI0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyImmunology
No246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist