Provider Demographics
NPI:1467864629
Name:PHILLIPS, AMY MICHELLE (MS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 N RIDGE RD
Mailing Address - Street 2:#400
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1213
Mailing Address - Country:US
Mailing Address - Phone:316-462-3636
Mailing Address - Fax:
Practice Address - Street 1:3636 N RIDGE RD
Practice Address - Street 2:#400
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1213
Practice Address - Country:US
Practice Address - Phone:316-462-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program