Healthcare Provider Details

I. General information

NPI: 1205932134
Provider Name (Legal Business Name): BARBARA J PHELPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA J PHELPS CFNP

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 W NORTHSIDE DR
JACKSON MS
39213-4454
US

IV. Provider business mailing address

3510 PEMBERTON SQUARE BLVD
VICKSBURG MS
39180-5506
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-5321
  • Fax: 601-364-2600
Mailing address:
  • Phone: 601-501-6991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR586773
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: