Provider Demographics
NPI:1760042469
Name:NUNN, PHYLLIS ALANYA (MT)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ALANYA
Last Name:NUNN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:PHYLLIS
Other - Middle Name:A
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT CERTIFICATION
Mailing Address - Street 1:840 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-3028
Mailing Address - Country:US
Mailing Address - Phone:270-519-3514
Mailing Address - Fax:270-494-2172
Practice Address - Street 1:840 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-3028
Practice Address - Country:US
Practice Address - Phone:270-519-3514
Practice Address - Fax:270-494-2172
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172141225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760042469OtherNPI NUMBER