Provider Demographics
NPI:1902532625
Name:PHILLIPS, HEATHER ELAINE
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELAINE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7335 YANKEE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-1253
Mailing Address - Country:US
Mailing Address - Phone:513-564-6818
Mailing Address - Fax:513-564-6819
Practice Address - Street 1:7335 YANKEE RD STE 201
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-1253
Practice Address - Country:US
Practice Address - Phone:513-564-6818
Practice Address - Fax:513-564-6819
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0032316363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0018534Medicaid