Provider Demographics
NPI:1992779466
Name:PHILLIPS, EMILY NAN (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:NAN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28380-1446
Mailing Address - Country:US
Mailing Address - Phone:910-895-6650
Mailing Address - Fax:910-895-6682
Practice Address - Street 1:125 BILTMORE DR
Practice Address - Street 2:SUITE #2
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4994
Practice Address - Country:US
Practice Address - Phone:910-895-6650
Practice Address - Fax:910-895-6682
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000398363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0401PAMedicaid
NC2765996AOtherMEDICARE
NC2765996AOtherMEDICARE