Provider Demographics
NPI:1952323297
Name:PHILLIPS, TONYA L (MD)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 11449
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4005
Mailing Address - Country:US
Mailing Address - Phone:479-709-1924
Mailing Address - Fax:479-709-7499
Practice Address - Street 1:3808 GARY ST
Practice Address - Street 2:SUITE B
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5450
Practice Address - Country:US
Practice Address - Phone:479-709-7050
Practice Address - Fax:479-709-7051
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-74872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121637001Medicaid
130008161OtherRR MEDICARE
130008161OtherRR MEDICARE
AR121637001Medicaid