Provider Demographics
NPI:1790276608
Name:SCHAFER, PHILLIP ALLEN (AGACNP-BC)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:ALLEN
Last Name:SCHAFER
Suffix:
Gender:
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S MONTEZUMA ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4720
Mailing Address - Country:US
Mailing Address - Phone:928-277-0001
Mailing Address - Fax:928-350-6228
Practice Address - Street 1:212 S MONTEZUMA ST STE 3
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4720
Practice Address - Country:US
Practice Address - Phone:928-277-0001
Practice Address - Fax:928-350-6228
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11322363LA2100X
AZAP11311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1437992112OtherGRANITE MOUNTAIN LLC