Healthcare Provider Details

I. General information

NPI: 1013703313
Provider Name (Legal Business Name): MACEY B PHILLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 N 19TH ST
MONROE LA
71201-4554
US

IV. Provider business mailing address

1761 N 19TH ST
MONROE LA
71201-4554
US

V. Phone/Fax

Practice location:
  • Phone: 318-509-8073
  • Fax: 318-703-5765
Mailing address:
  • Phone: 318-509-8073
  • Fax: 318-703-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: