Provider Demographics
NPI:1871093641
Name:PHILLIPS, SHI JEAN (LVN)
Entity type:Individual
Prefix:
First Name:SHI
Middle Name:JEAN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BRADY
Mailing Address - State:TX
Mailing Address - Zip Code:76825-6234
Mailing Address - Country:US
Mailing Address - Phone:325-793-7024
Mailing Address - Fax:
Practice Address - Street 1:1104 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BRADY
Practice Address - State:TX
Practice Address - Zip Code:76825-6234
Practice Address - Country:US
Practice Address - Phone:325-792-7480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-18
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308839164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX308839Medicaid