Provider Demographics
NPI:1174518104
Name:PHILLIPS, KARYNTHIA A (MSM,PA-C)
Entity type:Individual
Prefix:MRS
First Name:KARYNTHIA
Middle Name:A
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSM,PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 MURFREESBORO PIKE
Mailing Address - Street 2:SUITE 109-110
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3341
Mailing Address - Country:US
Mailing Address - Phone:615-833-6898
Mailing Address - Fax:615-833-6895
Practice Address - Street 1:2275 MURFREESBORO PIKE
Practice Address - Street 2:SUITE 109-110
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3341
Practice Address - Country:US
Practice Address - Phone:615-833-6898
Practice Address - Fax:615-833-6895
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA841363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36692701OtherMEDICARE OTHER TULLAHOMA
TN36692701Medicaid
TNTN0101OtherTULLAHOMA AMERICHOICE
TN1174518104OtherNPI
TN3669270Medicaid
TN36692701OtherTULLAHOMA MEDICARE
TN4044007OtherDUE WEST BCBS
TN4137131OtherDUE WEST BCBS
TN4144463OtherTULLAHOMA BCBS
TN3669274Medicaid
TN4131037OtherBCBS
TN3669274OtherMEDICARE OTHER DUE WEST
TN3669270Medicare ID - Type UnspecifiedMEDICARE