Provider Demographics
NPI:1013032879
Name:PHILLIPS, JOAN SHELTON (FNPBC)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:SHELTON
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 MEDICAL CAMPUS DR NW STE 102
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4093
Practice Address - Country:US
Practice Address - Phone:910-754-5988
Practice Address - Fax:910-754-5989
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-02927363LF0000X
NC5002927363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2592928OtherPTAN
NC7004010Medicaid
2592928OtherPTAN