Healthcare Provider Details

I. General information

NPI: 1447749122
Provider Name (Legal Business Name): KATHERINE PHILIPKOSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48MDG/RAF LAKENHEATH UNIT 5115
APO AE
09461
US

IV. Provider business mailing address

48 MDG/RAF LAKENHEATH UNIT 5115
APO AE
09461
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.139342
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1019394
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: