Provider Demographics
NPI:1255527040
Name:PHILLIPS, KATHRYN A (MSNRNCS)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSNRNCS
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSNRNCS
Mailing Address - Street 1:1020 MCARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2453
Mailing Address - Country:US
Mailing Address - Phone:931-728-2022
Mailing Address - Fax:931-723-1210
Practice Address - Street 1:1020 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2453
Practice Address - Country:US
Practice Address - Phone:931-728-2022
Practice Address - Fax:931-723-1210
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005914261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health