Healthcare Provider Details

I. General information

NPI: 1013428150
Provider Name (Legal Business Name): JEANNA PHILLIPS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 BROWNS LN
LOUISVILLE KY
40220-1535
US

IV. Provider business mailing address

3938 GILMAN AVE
LOUISVILLE KY
40207-2734
US

V. Phone/Fax

Practice location:
  • Phone: 502-452-6337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number3011755
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3011755
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: