Provider Demographics
NPI:1992576987
Name:PHILLIPS, JAPONICA LAMEKA (FNP)
Entity type:Individual
Prefix:
First Name:JAPONICA
Middle Name:LAMEKA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JAPONICA
Other - Middle Name:LAMEKA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 WINDSORCREST RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7106
Mailing Address - Country:US
Mailing Address - Phone:803-727-8901
Mailing Address - Fax:
Practice Address - Street 1:99 WINDSORCREST RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7106
Practice Address - Country:US
Practice Address - Phone:803-727-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily