Provider Demographics
NPI:1912905753
Name:PHILLIPS, ANGELA K (RN, MSN, CS, FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:K
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN, MSN, CS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-1907
Mailing Address - Country:US
Mailing Address - Phone:806-355-5721
Mailing Address - Fax:806-355-5775
Practice Address - Street 1:4400 S WASHINGTON ST
Practice Address - Street 2:SUITE 107
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79110-2052
Practice Address - Country:US
Practice Address - Phone:806-355-5721
Practice Address - Fax:806-355-5775
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX559456363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0383630-02Medicaid
TX559456OtherSTATE LICENSE
TXMP1043835OtherDEA#
TXMP1043835OtherDEA#
TX0383630-02Medicaid