Individual
TRACI MARLENA PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSN,RN,MSN,FNP-BC
Contact information
Practice address
723 9TH AVE, HUNTINGTON, WV 25701-2718
(045) 290-6453
(304) 529-3026
Mailing address
PO BOX 1680, HUNTINGTON, WV 25717-1680
(304) 528-6445
(304) 528-5220
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
66503
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3040355
—
OH
05
—
3810017383
—
WV
05
—
7100116110
—
KY
Enumeration date
11/10/2009
Last updated
05/30/2024
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