Phylana K Carruth, RN

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

R104827 Issued in AR

Practice address

915 W B St
Russellville, AR 72801-3501

Phone

(479) 968-1777

Fax

(479) 967-1111

NPI assigned

Aug 3, 2021

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

Other names 1

• Lana Cornwell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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.

• PKC Medical Supplies

  • Durable Medical Equipment & Medical Supplies
  • Russellville, AR
  • NPI 1366221293
  NPD

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

{
    "created_epoch": "1627948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1760156954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 W B ST",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728013501",
            "telephone_number": "479-968-1777",
            "fax_number": "470-967-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 W B ST",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728013501",
            "telephone_number": "479-968-1777",
            "fax_number": "479-967-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRUTH",
        "first_name": "PHYLANA",
        "middle_name": "K",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-03",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "AR",
            "license": "R104827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LANA",
            "last_name": "CORNWELL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Leticia Rebecca Caro
• Mason Konnor Carpenter, PTA
• Shaley Christine Carpenter
• Cheyenne Carr
• Alicia Cristina Carro Jimenez
• Camryn Jade Carter, COTA/L
• Iesha Carter
• Jacob Carter, RECOVERY ASSISTANT
• James Mark Carter, MD
• Olivia Carter, OT

• General Practice Registered Nurse in Russellville, AR
• Providers in Russellville, AR by specialty
• General Practice Registered Nurse in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 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.