Provider Demographics
NPI:1265552442
Name:PHILLIPS, KIMBERLY C (FNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:C
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:28 S MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4914
Practice Address - Country:US
Practice Address - Phone:573-331-3350
Practice Address - Fax:573-331-3351
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO151686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO623723OtherANTHEM BCBS
MOP00779924OtherRR MCR
MOQ62907Medicare UPIN
MO828733247Medicare PIN