MEDICARE: MRS. KRISTEN MARY PHILLIPS LM, CPM

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	176B00000X	Midwife	CNM1009	NC
2	367A00000X	Advanced Practice Midwife	1009	NC

General Provider Information

NPI Number	:	1518252485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTEN MARY PHILLIPS LM, CPM

Provider Business Mailing Address
First Line	:	500 SHEPHERD ST STE 500
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1633
Country	:	US
Telephone Number	:	336-716-4039
Fax Number	:	336-768-3497

Provider Business Practice Location Address
First Line	:	500 SHEPHERD ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-1633
Country	:	US
Telephone Number	:	336-716-4039
Fax Number	:

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

Provider Enumeration Date	:	06/18/2011
Last Update Date	:	02/24/2026

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