MEDICARE: MRS. KARYNTHIA A PHILLIPS MSM,PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA841	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36692701	OTHER	TN	MEDICARE OTHER TULLAHOMA
6	36692701	OTHER	TN	TULLAHOMA MEDICARE
12	3669274	OTHER	TN	MEDICARE OTHER DUE WEST

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	TN0101	OTHER	TN	TULLAHOMA AMERICHOICE
4	1174518104	OTHER	TN	NPI
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	4044007	OTHER	TN	DUE WEST BCBS
8	4137131	OTHER	TN	DUE WEST BCBS
9	4144463	OTHER	TN	TULLAHOMA BCBS
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	4131037	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1174518104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARYNTHIA A PHILLIPS MSM,PA-C

Provider Business Mailing Address
First Line	:	2275 MURFREESBORO PIKE
Second Line	:	SUITE 109-110
City	:	NASHVILLE
State	:	TN
Zip	:	37217-3341
Country	:	US
Telephone Number	:	615-833-6898
Fax Number	:	615-833-6895

Provider Business Practice Location Address
First Line	:	2275 MURFREESBORO PIKE
Second Line	:	SUITE 109-110
City	:	NASHVILLE
State	:	TN
Zip	:	37217-3341
Country	:	US
Telephone Number	:	615-833-6898
Fax Number	:	615-833-6895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	11/15/2012

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