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General NPI Number Information
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NPI Number | 1952407090
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Entity Type | Individual
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Provider Name | CYNTHIA KAYE PHILLIPS-JOHNSON RN, AGNP
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Gender | Female
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 3765 E BLUE LUPINE DR STE D
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City | WASILLA
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State | AK
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Zip | 99654-8417
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Country | US
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Telephone | 907-707-1671
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Fax | 907-707-1675
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Provider Business Mailing Address
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Address Line | 1399 S TIM AVE
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City | WASILLA
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State | AK
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Zip | 99623-9338
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Country | US
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Telephone | 385-201-4211
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 141780
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00017451
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 224414
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License Number State | AK
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