Provider Demographics
NPI:1659197382
Name:PHIPPS, LYDIA (APRN)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:HOLBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5908 HIGHWAY 460 E
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:41472-7654
Mailing Address - Country:US
Mailing Address - Phone:606-207-1561
Mailing Address - Fax:
Practice Address - Street 1:5908 HIGHWAY 460 E
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-7654
Practice Address - Country:US
Practice Address - Phone:606-207-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4029369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily