Individual
MADELINE GRACE PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
800 ROSE ST, LEXINGTON, KY 40536-7601
(859) 323-9057
(859) 323-9502
Mailing address
240 RICHLAND CHURCH RD, MORGANTOWN, KY 42261-7601
(270) 999-5703
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2892
KY
363A00000X
Physician Assistant
TC102
KY
363AM0700X
Medical Physician Assistant
PA2892
KY
363AM0700X
Medical Physician Assistant
TC102
KY
363AS0400X
Surgical Physician Assistant
PA2892
KY
363AS0400X
Surgical Physician Assistant
TC102
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/06/2020
Last updated
01/27/2022
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