Provider Demographics
NPI:1629080148
Name:PHELPS, CARLA R (ARNP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:R
Last Name:PHELPS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:R
Other - Last Name:HAYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0689
Mailing Address - Country:US
Mailing Address - Phone:606-864-7337
Mailing Address - Fax:606-878-3257
Practice Address - Street 1:1102 S MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1529
Practice Address - Country:US
Practice Address - Phone:606-770-5121
Practice Address - Fax:606-770-5199
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3903P363L00000X
KY3003903363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78013547Medicaid
KY78013547Medicaid