Provider Demographics
NPI:1982940995
Name:PHILLIPS, KATHERINE H (FNP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:H
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2029
Mailing Address - Country:US
Mailing Address - Phone:410-558-4888
Mailing Address - Fax:410-510-1393
Practice Address - Street 1:1245 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3422
Practice Address - Country:US
Practice Address - Phone:410-558-4700
Practice Address - Fax:410-780-0364
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR192355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD376751500Medicaid