| Doctor Name: | SANDRA PHELPS |
| NPI Number: | 1013391424 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PA00226 |
| Business Practice Address: | 188 Ymca Pl Vicksburg, MS - 391833536 |
| Business Phone Number: | 6016367222 |
| Business Fax Number: | 6016360440 |
| Mailing Address: | 2124 Eva Ave, OCEAN SPRINGS |
| State: | MS |
| Postal Code: | 395645032 |
| Phone Number: | 2283277668 |
| Fax Number: | |
| NPI Enumeration Date: | 07/15/2015 |
| NPI Last Update Date: | 07/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA00226 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |