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General NPI Number Information
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NPI Number | 1134798564
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Entity Type | Individual
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Provider Name | JENNIFER WALKER PHELPS NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 06/21/2021
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 1107A BROOKDALE ST
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City | MARTINSVILLE
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State | VA
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Zip | 24112-4501
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Country | US
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Telephone | 276-670-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 213 S JEFFERSON ST
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City | ROANOKE
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State | VA
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Zip | 24011-1705
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0001207898
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024181461
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License Number State | VA
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