Provider Demographics
NPI:1801541719
Name:PHILLIPS, KRISTAIN NICOLE (NP)
Entity type:Individual
Prefix:
First Name:KRISTAIN
Middle Name:NICOLE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4689 N STATE ROAD 9
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-1050
Mailing Address - Country:US
Mailing Address - Phone:765-639-4141
Mailing Address - Fax:
Practice Address - Street 1:4689 N STATE ROAD 9
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-1050
Practice Address - Country:US
Practice Address - Phone:765-639-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28207557A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner