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
State | License ID | Taxonomies |
---|---|---|
246QB0000X, 246QM0900X, 246QC1000X, 246QH0000X, 246QI0000X, 246QL0900X | ||
TN | 0000024390 | 246QM0706X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 246QL0900X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Laboratory Management |
No | 246QB0000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Blood Banking |
No | 246QM0900X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Microbiology |
No | 246QC1000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Chemistry |
No | 246QH0000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Hematology |
No | 246QI0000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Immunology |
No | 246QM0706X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Pathology | Medical Technologist |