| Doctor Name: | MRS. SHANNON BARDIN PHELPS |
| NPI Number: | 1255468781 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | F.N.P. |
| License Number: | 201344 |
| Business Practice Address: | 110a Village Rd Ne Leland, NC - 284517412 |
| Business Phone Number: | 9103710055 |
| Business Fax Number: | 9103710061 |
| Mailing Address: | Po Box 1369, SHALLOTTE |
| State: | NC |
| Postal Code: | 284591369 |
| Phone Number: | 9108422443 |
| Fax Number: | |
| NPI Enumeration Date: | 02/28/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 201344 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |