Provider Demographics
NPI:1679190532
Name:PHILLIPS, JAIME (PMHNP, RN)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PMHNP, RN
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:STANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1280 MIDDLE TN BLVD APT F13
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-0938
Mailing Address - Country:US
Mailing Address - Phone:615-785-3345
Mailing Address - Fax:
Practice Address - Street 1:482 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3485
Practice Address - Country:US
Practice Address - Phone:931-444-1000
Practice Address - Fax:931-728-1229
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28055363LP0808X
TN2020001645363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health