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General NPI Number Information
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NPI Number | 1104101047
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Entity Type | Individual
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Provider Name | AMANDA JO PHELPS NP
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Gender | Female
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 220 E VIRGINIA ST
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City | EVANSVILLE
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State | IN
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Zip | 47711-5530
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Country | US
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Telephone | 812-777-0127
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3276
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City | EVANSVILLE
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State | IN
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Zip | 47731-3276
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Country | US
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Telephone | 812-473-0181
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 71003752A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 71003752A
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License Number State | IN
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