Provider Demographics
NPI:1346819802
Name:PHILLIPS, KENDALL (FNP)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4001
Mailing Address - Country:US
Mailing Address - Phone:803-722-8195
Mailing Address - Fax:
Practice Address - Street 1:111 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4001
Practice Address - Country:US
Practice Address - Phone:580-372-2819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-20
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK204182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily