Provider Demographics
NPI:1053539155
Name:CUMMINGS, PHILLIP HOWARD (FNP)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:HOWARD
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 DEVONSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-8110
Mailing Address - Country:US
Mailing Address - Phone:910-799-5153
Mailing Address - Fax:
Practice Address - Street 1:WOMACK ARMY MEDICAL CTR
Practice Address - Street 2:FAMILY MEDICINE RESIDENCY CLINIC
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-8871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC85905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC201191Medicare UPIN