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General NPI Number Information
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NPI Number | 1699863514
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Entity Type | Individual
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Provider Name | KATHY DIANNE PHELPS APRN FNP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 3131 PARISA DR
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City | PADUCAH
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State | KY
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Zip | 42003-4584
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Country | US
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Telephone | 270-444-8000
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Fax | 270-444-8302
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Provider Business Mailing Address
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Address Line | PO BOX 1175
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City | CALVERT CITY
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State | KY
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Zip | 42029
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Country | US
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Telephone | 270-395-5388
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Fax | 270-395-1792
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3143P
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License Number State | KY
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