Provider Demographics
NPI:1013410158
Name:PHILLIPS, KATHERINE ANNE (APRN-FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:APRN-FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 N COUNTY ROAD 700
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IL
Mailing Address - Zip Code:62379-3011
Mailing Address - Country:US
Mailing Address - Phone:217-256-4100
Mailing Address - Fax:217-256-3800
Practice Address - Street 1:1102 N COUNTY ROAD 700
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IL
Practice Address - Zip Code:62379-3011
Practice Address - Country:US
Practice Address - Phone:217-256-4100
Practice Address - Fax:217-256-3800
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily