Healthcare Provider Details

I. General information

NPI: 1780487124
Provider Name (Legal Business Name): MRS. CARMEN MARIE PHELPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 E ROCK HAVEN RD STE 210
HARRISONVILLE MO
64701-4414
US

IV. Provider business mailing address

2800 E ROCK HAVEN RD
HARRISONVILLE MO
64701-4411
US

V. Phone/Fax

Practice location:
  • Phone: 816-380-7470
  • Fax: 816-710-8818
Mailing address:
  • Phone: 816-887-0310
  • Fax: 816-887-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2024019629
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: