Healthcare Provider Details

I. General information

NPI: 1063772978
Provider Name (Legal Business Name): JACQUELINE NICOLE MARY PHELPS CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 COOL SPRINGS BLVD
FRANKLIN TN
37067-7289
US

IV. Provider business mailing address

730 COOL SPRINGS BLVD
FRANKLIN TN
37067-7289
US

V. Phone/Fax

Practice location:
  • Phone: 800-918-8924
  • Fax:
Mailing address:
  • Phone: 800-918-8924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC0000000049
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: