Provider Demographics
NPI:1477744894
Name:PHILLIPS, RICKY WAYNE (DNP)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:WAYNE
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3801 HOUMA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4165
Mailing Address - Country:US
Mailing Address - Phone:504-309-8135
Mailing Address - Fax:504-309-8156
Practice Address - Street 1:3801 HOUMA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4165
Practice Address - Country:US
Practice Address - Phone:504-309-8135
Practice Address - Fax:504-309-8156
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05272363LF0000X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1029246Medicaid
LA1029246Medicaid