Provider Demographics
NPI:1568691905
Name:PHILLIPS, KYLE (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-2416
Mailing Address - Country:US
Mailing Address - Phone:719-480-4796
Mailing Address - Fax:
Practice Address - Street 1:540 S DUPONT HWY STE 2
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4523
Practice Address - Country:US
Practice Address - Phone:302-744-1064
Practice Address - Fax:302-739-2549
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2023-05-01
Deactivation Date:2010-04-26
Deactivation Code:
Reactivation Date:2014-03-28
Provider Licenses
StateLicense IDTaxonomies
PARN590406163WG0000X
PASP023631363LF0000X
DELG-0000702363LF0000X
DEL1-0032177163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily