Provider Demographics
NPI:1598101925
Name:KELLIHER, PHYLLIS D (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:D
Last Name:KELLIHER
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1798
Mailing Address - Country:US
Mailing Address - Phone:508-674-5600
Mailing Address - Fax:401-434-5230
Practice Address - Street 1:795 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1798
Practice Address - Country:US
Practice Address - Phone:508-674-5600
Practice Address - Fax:401-434-5230
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37754363L00000X
RIAPRN00058363LA2200X
MARN2324041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health