Individual
ANDREA FAITH PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 962-2082
(317) 962-0585
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28184780A
IN
363LF0000X
Family Nurse Practitioner
Primary
71011923A
IN
364SG0600X
Gerontology Clinical Nurse Specialist
71011923A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001635745
ANTHEM PTAN
IN
01
—
264430D65
MEDICARE
IN
05
—
300058545
—
IN
01
—
Q00642883
RAILROAD PTAN
IN
Enumeration date
12/21/2021
Last updated
02/17/2025
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