Basic Information
| Provider Information | |||||||||
| NPI: | 1326056037 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | CECILIA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2005 POLK ST | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713016342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184512732 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3983 I-49 SOUTH SERVICE ROAD | ||||||||
| Address2: | OPELOUSAS GENERAL HOSPITAL SOUTH CAMPUS | ||||||||
| City: | OPELOUSAS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379483011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 12/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 025511 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1578690 | 05 | LA | MEDICAID |