MEDICARE: KAREN N PHILLIPPS MD PA

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	207Q00000X	Family Medicine Physician	ME88539	FL

General Provider Information

NPI Number	:	1619902186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN N PHILLIPPS MD PA

Provider Business Mailing Address
First Line	:	851 CHALET SUZANNE RD
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-7759
Country	:	US
Telephone Number	:	863-679-9916
Fax Number	:	863-679-9826

Provider Business Practice Location Address
First Line	:	851 CHALET SUZANNE ROAD
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859
Country	:	US
Telephone Number	:	863-679-9916
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. KAREN NICOLE PHILLIPPS
Credential	:
Telephone Number	:	863-679-9916

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/26/2024

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