Provider Demographics
NPI:1487164729
Name:PHILLIPS, TABBY FAYE (RN)
Entity type:Individual
Prefix:MRS
First Name:TABBY
Middle Name:FAYE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 HEWGLEYS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380-6100
Mailing Address - Country:US
Mailing Address - Phone:423-619-3378
Mailing Address - Fax:
Practice Address - Street 1:1301 RIVERFRONT PKWY STE 209
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-3312
Practice Address - Country:US
Practice Address - Phone:423-634-5886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-30
Last Update Date:2017-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000195304163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse