Healthcare Provider Details

I. General information

NPI: 1568691905
Provider Name (Legal Business Name): KYLE PHILLIPS FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date: 04/26/2010
Reactivation Date: 03/28/2014

III. Provider practice location address

1605 LITITZ PIKE
LANCASTER PA
17601-6507
US

IV. Provider business mailing address

1605 LITITZ PIKE
LANCASTER PA
17601-6507
US

V. Phone/Fax

Practice location:
  • Phone: 717-735-3995
  • Fax: 717-735-9938
Mailing address:
  • Phone: 717-735-3995
  • Fax: 717-735-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP023631
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: