Provider Demographics
NPI:1518252485
Name:PHILLIPS, KRISTEN MARY (LM, CPM)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MARY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9920 SW 56TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4354
Mailing Address - Country:US
Mailing Address - Phone:352-278-6160
Mailing Address - Fax:
Practice Address - Street 1:9920 SW 56TH LN
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4354
Practice Address - Country:US
Practice Address - Phone:352-278-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW239176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife