Healthcare Provider Details

I. General information

NPI: 1770846388
Provider Name (Legal Business Name): MELISSA HULGAN PHILLIPS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD
BATON ROUGE LA
70808
US

IV. Provider business mailing address

DEPT AT952639
ATLANTA GA
31192-2639
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-7163
  • Fax:
Mailing address:
  • Phone: 800-684-0857
  • Fax: 405-844-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07020
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: