Provider Demographics
NPI:1780451823
Name:PHILLIPS, WILLIAM ROBERT HUNTER (CHW-C)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROBERT HUNTER
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:CHW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-1717
Mailing Address - Country:US
Mailing Address - Phone:573-885-0885
Mailing Address - Fax:573-677-0567
Practice Address - Street 1:330 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-1717
Practice Address - Country:US
Practice Address - Phone:573-885-0885
Practice Address - Fax:573-677-0567
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014043120183700000X
MO15794172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No183700000XPharmacy Service ProvidersPharmacy Technician