Healthcare Provider Details

I. General information

NPI: 1568772382
Provider Name (Legal Business Name): JARYN ROYCE PHELPS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JARYN ROYCE PULICE AUD

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6035 FAIRVIEW RD
CHARLOTTE NC
28210-3256
US

IV. Provider business mailing address

6035 FAIRVIEW RD
CHARLOTTE NC
28210-3256
US

V. Phone/Fax

Practice location:
  • Phone: 704-838-8493
  • Fax: 704-838-8494
Mailing address:
  • Phone: 704-838-8493
  • Fax: 704-838-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number9065
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number654BD01
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: