Provider Demographics
NPI:1699663773
Name:PHILLIPS, KADESHA (CNA/CHHA)
Entity type:Individual
Prefix:
First Name:KADESHA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CNA/CHHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13552 HIGHWAY 82 TRLR 5
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-0484
Mailing Address - Country:US
Mailing Address - Phone:918-525-7803
Mailing Address - Fax:
Practice Address - Street 1:13552 HIGHWAY 82 TRLR 5
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-0484
Practice Address - Country:US
Practice Address - Phone:918-525-7803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)