Provider Demographics
NPI:1912300286
Name:LARUE, PHYLLIS JEAN (NP)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:JEAN
Last Name:LARUE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 HELTON RD
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-9655
Mailing Address - Country:US
Mailing Address - Phone:806-665-7070
Mailing Address - Fax:806-661-4410
Practice Address - Street 1:1995 HELTON RD
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-9655
Practice Address - Country:US
Practice Address - Phone:806-665-7070
Practice Address - Fax:806-661-4410
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP110267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily