Provider Demographics
NPI:1043327729
Name:PHILIPOSE, ANITA S (ARNP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:S
Last Name:PHILIPOSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:S
Other - Last Name:VARGHESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,BSN
Mailing Address - Street 1:1303 N MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2331
Mailing Address - Country:US
Mailing Address - Phone:502-417-4956
Mailing Address - Fax:
Practice Address - Street 1:1303 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2331
Practice Address - Country:US
Practice Address - Phone:502-417-4956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3540P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY500020605OtherRAILROAD MEDICARE
KY78005915Medicaid
KY1023207Medicare PIN
KY78005915Medicaid