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NPI Code Detail

MEDICARE: CARL DOUGLAS PHILLIPS JR. FNP-C

MEDICARE: CARL DOUGLAS PHILLIPS JR. FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAP06562LA
2363LF0000XFamily Nurse PractitionerRN115788-AP06562LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679853477
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARL DOUGLAS PHILLIPS JR. FNP-C
Provider Business Mailing Address
First Line : 500 IDLEWOOD DR
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71303-3455
Country : US
Telephone Number : 337-400-4683
Fax Number :
Provider Business Practice Location Address
First Line : 109 YORKTOWN DR STE A
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71303-3673
Country : US
Telephone Number : 318-542-4288
Fax Number : 318-704-6201
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2011
Last Update Date : 04/05/2024

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