Provider Demographics
NPI:1922386804
Name:WILLIFORD, PHILLIP ANDREW (PA-C)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:ANDREW
Last Name:WILLIFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 RUNNYMEADE DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-8771
Mailing Address - Country:US
Mailing Address - Phone:270-227-0828
Mailing Address - Fax:
Practice Address - Street 1:3094 HARRODSBURG RD STE 201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2897
Practice Address - Country:US
Practice Address - Phone:859-605-8060
Practice Address - Fax:859-605-8061
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1679363A00000X
KYTC030363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant