Provider Demographics
NPI:1205856408
Name:PHELPS, JENIFER (NP)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 NETTLE CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3782
Mailing Address - Country:US
Mailing Address - Phone:910-790-9103
Mailing Address - Fax:910-798-5199
Practice Address - Street 1:4810 WRIGHTSVILLE AVE
Practice Address - Street 2:THE PRESBYTERIAN COUNSELING CENTER
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6917
Practice Address - Country:US
Practice Address - Phone:910-452-7370
Practice Address - Fax:910-798-5199
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900221363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC010064352OtherRAILROAD MEDICARE
NC7000680Medicaid
NCS99471Medicare UPIN
NC7000680Medicaid