Individual
LARRY D PHIPPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1400 W 4TH ST, COFFEYVILLE, KS 67337-3306
(620) 252-1200
Mailing address
9863 N SPRING VALLEY RD, GRAVETTE, AR 72736-9735
(620) 423-0857
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
54086
KS
367500000X
Certified Registered Nurse Anesthetist
C001304
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043406
BCBS
KS
05
—
100246250B
—
KS
05
—
200017590A
—
OK
01
—
430073196
RAILROAD MEDICARE
—
Enumeration date
03/08/2006
Last updated
01/24/2020
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