Provider Demographics
NPI:1396291399
Name:PHILLIPPI, CARMEN ANNE (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:ANNE
Last Name:PHILLIPPI
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 CHERRYBROOK ST
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-8817
Mailing Address - Country:US
Mailing Address - Phone:580-736-1142
Mailing Address - Fax:
Practice Address - Street 1:2210 DUNCAN REGIONAL LOOP
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1564
Practice Address - Country:US
Practice Address - Phone:580-251-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK84296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily