Provider Demographics
NPI:1619983939
Name:PHILIPS, BOBBI KAY (DI)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:KAY
Last Name:PHILIPS
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:BOBBI
Other - Middle Name:KAY
Other - Last Name:SUNDERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1141 BEACH DR E
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-4937
Mailing Address - Country:US
Mailing Address - Phone:360-895-4710
Mailing Address - Fax:360-895-4453
Practice Address - Street 1:1141 BEACH DR E
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4937
Practice Address - Country:US
Practice Address - Phone:360-895-4710
Practice Address - Fax:360-895-4453
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA714446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered