MEDICARE: MRS. KIMBERLY C PHILLIPS FNP

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	363LF0000X	Family Nurse Practitioner	151686	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	623723	OTHER	MO	ANTHEM BCBS
2	P00779924	OTHER	MO	RR MCR

General Provider Information

NPI Number	:	1265552442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY C PHILLIPS FNP

Provider Business Mailing Address
First Line	:	PO BOX 801143
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-1143
Country	:	US
Telephone Number	:	573-331-5583
Fax Number	:	573-331-5079

Provider Business Practice Location Address
First Line	:	28 S MOUNT AUBURN RD
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-4914
Country	:	US
Telephone Number	:	573-331-3350
Fax Number	:	573-331-3351

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	03/02/2021

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