Provider Demographics
NPI:1639227689
Name:PHILLIPS, KRISTY LYNN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 BRUSHY MOUNTAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-8478
Mailing Address - Country:US
Mailing Address - Phone:336-838-7928
Mailing Address - Fax:336-838-7941
Practice Address - Street 1:1355 BRUSHY MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-8478
Practice Address - Country:US
Practice Address - Phone:336-838-7928
Practice Address - Fax:336-838-7941
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3554163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health