Provider Demographics
NPI:1942831565
Name:PHILLIPS, DOREEN (APRN)
Entity type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14090 SOUTHWEST FWY STE 300
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3679
Mailing Address - Country:US
Mailing Address - Phone:833-744-5935
Mailing Address - Fax:833-777-6653
Practice Address - Street 1:9036 35TH AVE SW STE B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3821
Practice Address - Country:US
Practice Address - Phone:832-390-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-01
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX859555163WC0400X, 163WP0808X
TX1034616363LP0808X
CARN95280740363LP0808X
AZ258356363LP0808X
IL209023667363LP0808X
CANP95020768363LP0808X
WAAP61160521363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty