Basic Information
| Provider Information | |||||||||
| NPI: | 1225006612 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHILPOT | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | GNP BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3691 RUTGER AVE | ||||||||
| Address2: | PROVIDER ENROLLMENT | ||||||||
| City: | ST LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149774440 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3660 VISTA | ||||||||
| Address2: | |||||||||
| City: | ST LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149776055 | ||||||||
| FaxNumber: | 3147718575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 03/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 069267 | MO | Y | Nursing Service Providers | Registered Nurse | 363LG0600X | 069267 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.