| Organization Name: | PHELPS FAMILY PRACTICE, PLLC |
| NPI Number: | 1285830414 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHANNON BARDIN PHELPS (OWNER) |
| Mailing Address: | 204 Smith Ave Shallotte |
| State: | NC US |
| Postal Code: | 284704458 |
| Phone Number: | 9108422443 |
| Fax Number: | |
| NPI Enumeration Date: | 06/25/2007 |
| NPI Last Update Date: | 07/20/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |