Provider Demographics
NPI:1598212920
Name:PHILLIPS, KARI LARENE
Entity Type:Individual
Prefix:MRS
First Name:KARI
Middle Name:LARENE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KARI
Other - Middle Name:LARENE
Other - Last Name:RATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13000 LACRESTA DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-8924
Mailing Address - Country:US
Mailing Address - Phone:405-361-5495
Mailing Address - Fax:
Practice Address - Street 1:13000 LACRESTA DR
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-8924
Practice Address - Country:US
Practice Address - Phone:405-361-5495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator