Kelly Phillips, RN

Primary specialty

Gerontology Registered NurseTaxonomy code 163WG0600X

License

236257 Issued in GA

Practice address

415 Pendleton PL
Valdosta, GA 31602-2632

Phone

(229) 242-6868

NPI assigned

May 20, 2025

Last updated

May 20, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kelly Vaught Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747699200000",
    "number": "1477345023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 PENDLETON PL",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022632",
            "telephone_number": "229-242-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 PENDLETON PL",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022632",
            "telephone_number": "229-242-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "KELLY",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-20",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "GA",
            "license": "236257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "VAUGHT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Thomas E Phillips, MD
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• Physicians Preferred Med Equip Sev

• Gerontology Registered Nurse in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Gerontology Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.