Provider Demographics
NPI:1184632648
Name:PHILLIPS, KATHLEEN FRANCES (NP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:FRANCES
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:FRANCES
Other - Last Name:PALUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9050 LAPP ROAD
Mailing Address - Street 2:APPT 1
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032
Mailing Address - Country:US
Mailing Address - Phone:716-741-0068
Mailing Address - Fax:
Practice Address - Street 1:3495 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1129
Practice Address - Country:US
Practice Address - Phone:716-862-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300576-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health