Provider Demographics
NPI:1326056037
Name:PHILLIPS, NATALIE CECILIA (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:CECILIA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 POLK ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-6342
Mailing Address - Country:US
Mailing Address - Phone:318-451-2732
Mailing Address - Fax:
Practice Address - Street 1:3983 I-49 SOUTH SERVICE ROAD
Practice Address - Street 2:OPELOUSAS GENERAL HOSPITAL SOUTH CAMPUS
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70571
Practice Address - Country:US
Practice Address - Phone:337-948-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1578690Medicaid
LA1578690Medicaid
LA4E483Medicare ID - Type Unspecified