Provider Demographics
NPI:1225617582
Name:PHILLIPS, KAELA NORTON (PA)
Entity type:Individual
Prefix:
First Name:KAELA
Middle Name:NORTON
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAELA
Other - Middle Name:
Other - Last Name:NORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3900 CROSBY DR APT 1504
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1863
Mailing Address - Country:US
Mailing Address - Phone:502-767-1309
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE C300
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-1780
Practice Address - Country:US
Practice Address - Phone:859-257-5405
Practice Address - Fax:859-323-5483
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2950363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical