Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | 200836590 | MS |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 903736 | MS |
NPI | 1083252753 |
---|---|
Provider Name | Mrs. Danielle Phillips |
First Address | Flowood, MS 39232-9019 |
Second Address | Flowood, MS 39232-9019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2019 |
Last Update Date | 13/02/2020 |