| NPI | 1184738593 |
|---|---|
| Former Name | STACEY LYNN PHILLIPS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3004185) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3004185) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2024-07-22 |