MEDICARE: KASSIE PHILLIPS RN

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	163W00000X	Registered Nurse	1059262	TX

General Provider Information

NPI Number	:	1508714189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSIE PHILLIPS RN

Provider Business Mailing Address
First Line	:	20810 COUNTY ROAD 2340
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79423-6818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20810 COUNTY ROAD 2340
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79423-6818
Country	:	US
Telephone Number	:	205-359-2308
Fax Number	:

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

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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