MEDICARE: MARTHA R PHILPOT 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
1	363LF0000X	Family Nurse Practitioner	RN140760	LA

General Provider Information

NPI Number	:	1790634004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA R PHILPOT FNP-C

Provider Business Mailing Address
First Line	:	4501 JACKSON ST EXT STE C355
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2555
Country	:	US
Telephone Number	:	318-528-5131
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 JACKSON ST EXT STE C355
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2555
Country	:	US
Telephone Number	:	318-528-5131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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