Healthcare Provider Details

I. General information

NPI: 1740039940
Provider Name (Legal Business Name): CHASE PHILLIPS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2024
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 HARRODSBURG RD STE 125
LEXINGTON KY
40504-3543
US

IV. Provider business mailing address

2195 HARRODSBURG RD STE 125
LEXINGTON KY
40504-3543
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6371
  • Fax: 859-257-3585
Mailing address:
  • Phone: 859-323-6371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3570
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA3570
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3570
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: