Provider Demographics
NPI:1952641433
Name:PHILLIPS, KRISTI M (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22908 BOLLINGER TER
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-1733
Mailing Address - Country:US
Mailing Address - Phone:601-942-7502
Mailing Address - Fax:
Practice Address - Street 1:22000 DULLES RETAIL PLZ STE 124
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-2515
Practice Address - Country:US
Practice Address - Phone:703-282-5338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175482363LA2200X
MSR867696363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024175482OtherVA LICENSE