Provider Demographics
NPI:1366778144
Name:PHILLIPS, REBECCA SUE (FNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:SUE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:381 HILL ST
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-3510
Mailing Address - Country:US
Mailing Address - Phone:828-360-3600
Mailing Address - Fax:828-360-3602
Practice Address - Street 1:381 HILL ST
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-3510
Practice Address - Country:US
Practice Address - Phone:828-360-3600
Practice Address - Fax:828-360-3602
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03265ANP363LF0000X
NC5006742363LF0000X
TNAPN0000014292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1366778144Medicaid