Healthcare Provider Details

I. General information

NPI: 1508867763
Provider Name (Legal Business Name): BARRY CURTIS PHILLIPS N.P.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W 4TH ST
COFFEYVILLE KS
67337-3306
US

IV. Provider business mailing address

PO BOX 505262
SAINT LOUIS MO
63150-5262
US

V. Phone/Fax

Practice location:
  • Phone: 620-688-6566
  • Fax: 620-688-6577
Mailing address:
  • Phone: 620-688-6566
  • Fax: 620-688-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44088
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: