Provider Demographics
NPI:1073845152
Name:PHELPS, MEAGAN LAUREN (CPED)
Entity Type:Individual
Prefix:MISS
First Name:MEAGAN
Middle Name:LAUREN
Last Name:PHELPS
Suffix:
Gender:F
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:892 US HIGHWAY 264 BYP
Mailing Address - Street 2:
Mailing Address - City:BELHAVEN
Mailing Address - State:NC
Mailing Address - Zip Code:27810-9771
Mailing Address - Country:US
Mailing Address - Phone:252-943-2307
Mailing Address - Fax:252-943-3076
Practice Address - Street 1:892 US HIGHWAY 264 BYP
Practice Address - Street 2:
Practice Address - City:BELHAVEN
Practice Address - State:NC
Practice Address - Zip Code:27810-9771
Practice Address - Country:US
Practice Address - Phone:252-943-2307
Practice Address - Fax:252-943-3076
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCPED3326225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter