Provider Demographics
NPI:1275127417
Name:PHILLIPS, KATELYN B (PA-C)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:B
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:B
Other - Last Name:BAUMGART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4307 FAIRACRES RD
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2330
Mailing Address - Country:US
Mailing Address - Phone:402-942-2871
Mailing Address - Fax:
Practice Address - Street 1:412 W 42ND ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2401
Practice Address - Country:US
Practice Address - Phone:308-865-2303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2023-08-07
Deactivation Date:2021-03-01
Deactivation Code:
Reactivation Date:2021-05-18
Provider Licenses
StateLicense IDTaxonomies
NE2596363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant