Provider Demographics
NPI:1013914688
Name:PHILLIPS, ANITA KAY (ARNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:KAY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:K
Other - Last Name:EMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP-C
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-301-8074
Mailing Address - Fax:859-301-4945
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-301-8074
Practice Address - Fax:859-301-4945
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003201363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2526449Medicaid
IN200473650Medicaid
KY78005147Medicaid
KYK023260Medicare PIN
KY78005147Medicaid
KY1349105Medicare PIN