Provider Demographics
NPI:1629760251
Name:PHILLIPS, LESA MARIE (MSN APRN FNP-C)
Entity Type:Individual
Prefix:MS
First Name:LESA
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSN 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 1:528 KENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1412
Mailing Address - Country:US
Mailing Address - Phone:606-922-9550
Mailing Address - Fax:
Practice Address - Street 1:101 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2178
Practice Address - Country:US
Practice Address - Phone:740-774-7266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily