Provider Demographics
NPI:1225115793
Name:PHELPS, ELIZABETH ANN (RN BSN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:PHELPS
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:618 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:KS
Mailing Address - Zip Code:66725-1921
Mailing Address - Country:US
Mailing Address - Phone:620-429-1513
Mailing Address - Fax:
Practice Address - Street 1:3405 S SCHIFFERDECKER AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1388
Practice Address - Country:US
Practice Address - Phone:417-347-7760
Practice Address - Fax:417-347-7778
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO134333163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse