Provider Demographics
NPI:1952983611
Name:PHILLIPS, BETTY
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 MAIN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1054
Mailing Address - Country:US
Mailing Address - Phone:304-694-3862
Mailing Address - Fax:304-471-2488
Practice Address - Street 1:503 MORGANTOWN AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-4388
Practice Address - Country:US
Practice Address - Phone:043-637-3753
Practice Address - Fax:304-363-7376
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker