Healthcare Provider Details

I. General information

NPI: 1972602886
Provider Name (Legal Business Name): SHAWNA LYN BULL PHELPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAWNA LYN BULL MD

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL PARK DR
ASHEVILLE NC
28803-2493
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 828-274-7502
  • Fax: 828-271-6599
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number2013-01236
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number2013-01236
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: