Healthcare Provider Details

I. General information

NPI: 1255481370
Provider Name (Legal Business Name): WILKERSON P PHILLIPS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PERDIDO ST
NEW ORLEANS LA
70112-1262
US

IV. Provider business mailing address

1764 WEDGWOOD DR
HARVEY LA
70058-7436
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-0811
  • Fax:
Mailing address:
  • Phone: 504-328-4079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPO1534
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: