# TRACI MARLENA PHILLIPS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1578890752
- **Gender:** F
- **Credential:** BSN,RN,MSN,FNP-BC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 66503 | WV | Yes |

## Other

- **Enumeration date:** 11/10/2009
- **Last updated:** 05/30/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3040355 | — | OH |
| 05 | — | 3810017383 | — | WV |
| 05 | — | 7100116110 | — | KY |