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General NPI Number Information
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NPI Number | 1275037186
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Entity Type | Individual
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Provider Name | KIMBERLY VICKERY PHILLIPS NP
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Gender | Female
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 11512 LAKE MEAD AVE UNIT 536
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9733
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Country | US
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Telephone | 904-222-6103
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Fax |
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Provider Business Mailing Address
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Address Line | 15280 NW 79TH CT STE 200
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City | MIAMI LAKES
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State | FL
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Zip | 33016-5873
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Country | US
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Telephone | 305-558-3724
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Fax | 786-907-4485
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN266565
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11021946
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License Number State | FL
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