Jacob Elizabeth Phillips, BSW

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

102 N Broadway St
Johnson City, TN 37601-3525

Phone

(423) 588-9978

NPI assigned

Sep 12, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dragonfly Medical and Behavioral Health Professsional Corporation

  • Addiction Medicine (Family Medicine) Physician
  • Johnson City, TN
  • NPI 1689134231
  NPD
• Dragfonfly Wellness Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Johnson City, TN
  • NPI 1134689730
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1245017235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 JOHNSON AVE APT G66",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376434589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 N BROADWAY ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376013525",
            "telephone_number": "423-588-9978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "JACOB",
        "middle_name": "ELIZABETH",
        "credential": "BSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-12",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Pettit, PA
• Kylee Leann Pettit, PA
• Pharmacy Specialty Services
• Brad Alan Phelps, RPH
• Brandon Michael Phillips
• Olivia Blake Phillips
• Angela Phipps
• Physical Therapy Specialists, PLLC
• Jose E Picaza, M.D.
• Courtney Pickel, PT

• Social Worker in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Social Worker in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.