Provider Demographics
NPI:1952407090
Name:PHILLIPS-JOHNSON, CYNTHIA KAYE (RN, AGNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KAYE
Last Name:PHILLIPS-JOHNSON
Suffix:
Gender:F
Credentials:RN, AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1399 S TIM AVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-9338
Mailing Address - Country:US
Mailing Address - Phone:385-201-4211
Mailing Address - Fax:
Practice Address - Street 1:3765 E BLUE LUPINE DR STE D
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8417
Practice Address - Country:US
Practice Address - Phone:907-707-1671
Practice Address - Fax:907-707-1675
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK141780163W00000X
WAMA00017451225700000X
AK224414363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist