Provider Demographics
NPI:1073810628
Name:PHILLIPS, KYLONI D (APN)
Entity Type:Individual
Prefix:MS
First Name:KYLONI
Middle Name:D
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 COIT RD
Mailing Address - Street 2:SUITE # 104
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6174
Mailing Address - Country:US
Mailing Address - Phone:318-230-9020
Mailing Address - Fax:972-519-1591
Practice Address - Street 1:1600 COIT RD
Practice Address - Street 2:SUITE # 104
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6174
Practice Address - Country:US
Practice Address - Phone:318-230-9020
Practice Address - Fax:972-519-1591
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX788454363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284967102Medicaid
TX284967101Medicaid
TXTXB138266Medicare PIN
TXTXB138271Medicare PIN