Provider Demographics
NPI:1427726975
Name:PHIPPS, KATIE LEE (RT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LEE
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 BARTLESON RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-6007
Mailing Address - Country:US
Mailing Address - Phone:707-849-1331
Mailing Address - Fax:
Practice Address - Street 1:4450 BARTLESON RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-6007
Practice Address - Country:US
Practice Address - Phone:707-849-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF00100925247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist