Active NPI
Kelly Phillips, DO
- Family Medicine Physician
- Prosper, TX
National Provider Identifier
1073593349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- M5441
- Practice address
- 821 N. Coleman St.
100
Prosper, TX 75078 - Phone
- (469) 800-5200
- Fax
- (469) 800-5210
- NPI assigned
- Jan 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M5441 | TX | Primary |
Addresses
Primary practice location
821 N. Coleman St.
100
Prosper, TX 75078
Mailing address
821 N. Coleman St.
100
Prosper, TX 75078
Phone (469) 800-5200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 284974701 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328486400000",
"number": "1073593349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "821 N. COLEMAN ST.",
"address_2": "100",
"city": "PROSPER",
"state": "TX",
"postal_code": "75078",
"telephone_number": "469-800-5200",
"fax_number": "469-800-5210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "821 N. COLEMAN ST.",
"address_2": "100",
"city": "PROSPER",
"state": "TX",
"postal_code": "75078",
"telephone_number": "469-800-5200",
"fax_number": "469-800-5210"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "KELLY",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-20",
"last_updated": "2012-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "M5441",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "284974701",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Prosper, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.