Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 4759 | OK |
Y | 207P00000X | Emergency Physician | OP60477228 | WA |
NPI | 1003047796 |
---|---|
Provider Name | Kelly A Phillips |
First Address | Lakewood, WA 98499-3004 |
Second Address | Lakewood, WA 98499-3004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2009 |
Last Update Date | 09/09/2014 |