Provider Demographics
NPI:1467530253
Name:OGLETREE, PHYLLIS D (CRNP)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:D
Last Name:OGLETREE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 11TH WAY
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:AL
Mailing Address - Zip Code:35127-2303
Mailing Address - Country:US
Mailing Address - Phone:205-515-5281
Mailing Address - Fax:
Practice Address - Street 1:400 VETERANS DRIVE
Practice Address - Street 2:OCCUPATIONAL HEALTH
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531
Practice Address - Country:US
Practice Address - Phone:228-523-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-039167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily