Healthcare Provider Details

I. General information

NPI: 1174411805
Provider Name (Legal Business Name): KODY LEWIS PHILPOTT PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 TELECOM DR STE 120
TEMPLE TERRACE FL
33637-0936
US

IV. Provider business mailing address

13101 TELECOM DR STE 120
TEMPLE TERRACE FL
33637-0936
US

V. Phone/Fax

Practice location:
  • Phone: 239-690-6906
  • Fax:
Mailing address:
  • Phone: 239-690-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11040346
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: