PHILLIPS, ALLISON GAYLE (APRN)

Provider Demographics

• NPI: 1760469134
• Name: PHILLIPS, ALLISON GAYLE (APRN)
• Entity Type: Individual
• Prefix: MRS
• First Name: ALLISON
• Middle Name: GAYLE
• Last Name: PHILLIPS
• Gender: F
• Credentials: APRN
• Other - First Name: ALLISON
• Other - Middle Name: GAYLE
• Other - Last Name: MARDIS
• Other - Last Name Type: Other Name
• Mailing Address - Street 1: 640 WATERTOWER BYP
• Mailing Address - City: CAMPBELLSVILLE
• Mailing Address - State: KY
• Mailing Address - Zip Code: 42718-8657
• Mailing Address - Country: US
• Mailing Address - Phone: 502-262-2887
• Practice Address - Street 1: 640 WATERTOWER BYP
• Practice Address - City: CAMPBELLSVILLE
• Practice Address - State: KY
• Practice Address - Zip Code: 42718-8657
• Practice Address - Country: US
• Practice Address - Phone: 502-262-2887
• Is Sole Proprietor?: No
• Enumeration Date: 2005-12-28
• Last Update Date: 2021-05-13

Provider Licenses

State	License ID	Taxonomies
KY	3002239	363L00000X, 363LF0000X, 363LW0102X, 363LP0808X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	363LP0808X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Psychiatric/Mental Health
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family
No	363LW0102X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Women's Health

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KY	78002102	Medicaid
KY	20029013	Medicaid
KY	20109013	Medicaid
KY	20901211	Medicaid
KY	2001012	Medicaid
KY	20027017	Medicaid
KY	20044012	Medicaid
KY	20104014	Medicaid
KY	20023016	Medicaid
KY	300514	Medicare PIN
KY	300614	Medicare PIN
KY	20104014	Medicaid
KY	300814	Medicare PIN
KY	20023016	Medicaid
KY	20027017	Medicaid
KY	20044012	Medicaid
KY	300014	Medicare PIN
KY	20029013	Medicaid
KY	20116018	Medicaid
KY	300116	Medicare PIN