Provider Demographics
NPI:1972903110
Name:PHILLIPS, BECKY LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 7TH ST
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:OR
Mailing Address - Zip Code:97882-9826
Mailing Address - Country:US
Mailing Address - Phone:541-922-1750
Mailing Address - Fax:541-922-1753
Practice Address - Street 1:1890 7TH ST
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:OR
Practice Address - Zip Code:97882-9826
Practice Address - Country:US
Practice Address - Phone:541-922-1750
Practice Address - Fax:541-922-1753
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60499126363LF0000X
OR201501464NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily