Provider Demographics
NPI:1992107882
Name:PHILLIPS, KRISTIN MAUREEN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MAUREEN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7825 BROAD RIVER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2375
Mailing Address - Country:US
Mailing Address - Phone:803-509-8844
Mailing Address - Fax:803-509-8845
Practice Address - Street 1:7825 BROAD RIVER RD STE 100
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2375
Practice Address - Country:US
Practice Address - Phone:803-509-8844
Practice Address - Fax:803-509-8845
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily