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General NPI Number Information
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NPI Number | 1316767205
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Entity Type | Individual
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Provider Name | COLTON JEFFERY PHELPS MSN, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 1675 CURLEW DR
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City | AMMON
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State | ID
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Zip | 83406-4718
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Country | US
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Telephone | 208-523-5319
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2106
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City | IDAHO FALLS
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State | ID
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Zip | 83403-2106
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 58777
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License Number State | ID
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