Provider Demographics
NPI:1871595751
Name:PHIPPS, PAUL STEVEN (CRNA - ARNP)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:STEVEN
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:CRNA - ARNP
Other - Prefix:MR
Other - First Name:PAUL
Other - Middle Name:STEVEN
Other - Last Name:PHIPPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA - ARNP
Mailing Address - Street 1:425 LEWIS HARGETT CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3590
Mailing Address - Country:US
Mailing Address - Phone:859-268-1030
Mailing Address - Fax:859-269-4120
Practice Address - Street 1:1 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3742
Practice Address - Country:US
Practice Address - Phone:859-313-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA-08266367500000X
KY1079622163WC0200X, 163WN0002X, 163WM0705X
OH307555163WC0200X, 163WM0705X, 163WN0002X
NH059072-23367500000X
KY3004373367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74008566Medicaid
KY74008566Medicaid