Provider Demographics
NPI:1760954754
Name:MCPHOY-PHILIPPEAU, KARESA A (DNP, FNP-BC, A-GNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KARESA
Middle Name:A
Last Name:MCPHOY-PHILIPPEAU
Suffix:
Gender:F
Credentials:DNP, FNP-BC, A-GNP-C
Other - Prefix:MRS
Other - First Name:KARESA
Other - Middle Name:A
Other - Last Name:MCPHOY-PHILIPPEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-BC, A-GNP
Mailing Address - Street 1:3380 RESERVOIR OVAL E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-3100
Mailing Address - Country:US
Mailing Address - Phone:187-696-4126
Mailing Address - Fax:
Practice Address - Street 1:3380 RESERVOIR OVAL E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-3100
Practice Address - Country:US
Practice Address - Phone:516-474-1132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308019363LA2200X
NY343734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM5098264OtherDRUG ENFORCEMENT ADMINISTRATION NY