Provider Demographics
NPI:1154729481
Name:PHILLIPS, KRISTIN LEA (APN)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:LEA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:APN
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Mailing Address - Street 1:501 GREAT CIRCLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1317
Mailing Address - Country:US
Mailing Address - Phone:615-269-4545
Mailing Address - Fax:615-565-6748
Practice Address - Street 1:4230 HARDING PIKE
Practice Address - Street 2:SUITE 330
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-269-4545
Practice Address - Fax:615-565-6748
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN17113363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ011669Medicaid
TN10311I1784Medicare PIN