Healthcare Provider Details

I. General information

NPI: 1902692858
Provider Name (Legal Business Name): NICOLE RAE ZEDIKER PHILLIPS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 SCHILLINGER RD S
MOBILE AL
36695-4177
US

IV. Provider business mailing address

6513 LIGHTHOUSE CT
MOBILE AL
36695-3267
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-0123
  • Fax:
Mailing address:
  • Phone: 251-232-9839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1-177663
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: