Provider Demographics
NPI:1598101925
Name:KELLIHER, PHYLLIS D (APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:D
Last Name:KELLIHER
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 CHALKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-4735
Mailing Address - Country:US
Mailing Address - Phone:401-456-2000
Mailing Address - Fax:401-434-5230
Practice Address - Street 1:825 CHALKSTONE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4735
Practice Address - Country:US
Practice Address - Phone:401-474-4288
Practice Address - Fax:401-434-5230
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00058363LF0000X, 363LA2200X
MARN2324041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health