Provider Demographics
NPI:1538043526
Name:PHILLIPS, TESS EMMA (RD, RDN, IBCLC)
Entity type:Individual
Prefix:
First Name:TESS
Middle Name:EMMA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RD, RDN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9031 HARRISON RUN CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1890
Mailing Address - Country:US
Mailing Address - Phone:361-774-4974
Mailing Address - Fax:
Practice Address - Street 1:3908 MEADOWS DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3114
Practice Address - Country:US
Practice Address - Phone:361-774-4974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86104229133VN1004X, 171400000X
INL-319389174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No171400000XOther Service ProvidersHealth & Wellness Coach