Provider Demographics
NPI:1316611510
Name:PHILLIPS, VILLICE NICOLE (CPT)
Entity type:Individual
Prefix:MS
First Name:VILLICE
Middle Name:NICOLE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:VILLICE
Other - Middle Name:NICOLE
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPT
Mailing Address - Street 1:5214 RONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-2859
Mailing Address - Country:US
Mailing Address - Phone:502-443-5582
Mailing Address - Fax:502-415-7322
Practice Address - Street 1:5214 RONWOOD DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-2859
Practice Address - Country:US
Practice Address - Phone:502-443-5582
Practice Address - Fax:502-415-7322
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty