Provider Demographics
NPI:1609466358
Name:PHILLIPS, CHARISSA BETH (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:CHARISSA
Middle Name:BETH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 RIDGEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4401
Mailing Address - Country:US
Mailing Address - Phone:859-270-8098
Mailing Address - Fax:
Practice Address - Street 1:848 RIDGEBROOK RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4401
Practice Address - Country:US
Practice Address - Phone:859-270-8098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014528363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily