=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255527040
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHRYN A PHILLIPS MSNRNCS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2007
-----------------------------------------------------
Last Update Date | 09/14/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1020 MCARTHUR ST
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37355-2453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-728-2022
-----------------------------------------------------
Fax | 931-723-1210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1020 MCARTHUR ST
-----------------------------------------------------
City | MANCHESTER
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37355-2453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-728-2022
-----------------------------------------------------
Fax | 931-723-1210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | APN0000005914
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------