=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023924180
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHRYN TERESA PHILLIPS APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2026
-----------------------------------------------------
Last Update Date | 08/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1215 PLEASANT ST STE 206
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50309-1419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-875-9092
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1125 NORTHVIEW DR
-----------------------------------------------------
City | WAUKEE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50263-9234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-217-0576
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | A193536
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------