Provider Demographics
NPI:1386472553
Name:PHIPPS, MANDY LYNETTE
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:LYNETTE
Last Name:PHIPPS
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 1:437 COUNTY ROAD 3542
Mailing Address - Street 2:
Mailing Address - City:HONEY GROVE
Mailing Address - State:TX
Mailing Address - Zip Code:75446-7011
Mailing Address - Country:US
Mailing Address - Phone:903-227-3553
Mailing Address - Fax:
Practice Address - Street 1:437 COUNTY ROAD 3542
Practice Address - Street 2:
Practice Address - City:HONEY GROVE
Practice Address - State:TX
Practice Address - Zip Code:75446-7011
Practice Address - Country:US
Practice Address - Phone:903-227-3553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily