Provider Demographics
NPI:1619916988
Name:PHILLIPS-WILSON, KAREN JANE (CRNA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JANE
Last Name:PHILLIPS-WILSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LAKE CREST DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-3825
Mailing Address - Country:US
Mailing Address - Phone:865-986-4405
Mailing Address - Fax:
Practice Address - Street 1:124 LAKE CREST DR
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-3825
Practice Address - Country:US
Practice Address - Phone:865-986-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN68495/APN9345367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3604909Medicaid
TN4118625OtherBCBS TN
TNP00301214Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TN3604909Medicare ID - Type UnspecifiedCIGNA GOVERNMENT SERVICES