Healthcare Provider Details

I. General information

NPI: 1982348017
Provider Name (Legal Business Name): EMILY PHELPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIR
CAMP PENDLETON AR
92055-5191
US

IV. Provider business mailing address

1546 6TH ST
TWENTYNINE PALMS CA
92277
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101279291
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: