Provider Demographics
NPI:1881725125
Name:PHILLIPS, JANE ELLEN (APRN)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ELLEN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 FARR SHORES DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-9622
Mailing Address - Country:US
Mailing Address - Phone:501-590-8525
Mailing Address - Fax:
Practice Address - Street 1:200 HEARTCENTER LN
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6351
Practice Address - Country:US
Practice Address - Phone:501-624-6641
Practice Address - Fax:501-321-4890
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA02956363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPENDINGMedicare UPIN
ARPENDINGMedicare ID - Type Unspecified
5A319Medicare PIN