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General NPI Number Information
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NPI Number | 1285830414
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Entity Type | Organization
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Legal Business Name | PHELPS FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 204 SMITH AVE
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City | SHALLOTTE
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State | NC
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Zip | 28470-4458
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Country | US
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Telephone | 910-842-2443
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1369
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City | SHALLOTTE
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State | NC
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Zip | 28459-1369
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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 | OWNER
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Name | MRS. SHANNON BARDIN PHELPS
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Credential | F.N.P.
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Telephone | 910-842-2443
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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 |
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License Number State |
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