Provider Demographics
NPI:1255513107
Name:PHELPS, JOSHUA RAPHAEL (FNP, DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:RAPHAEL
Last Name:PHELPS
Suffix:
Gender:M
Credentials:FNP, DC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1900 WASHINGTON BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-6850
Mailing Address - Country:US
Mailing Address - Phone:801-612-1085
Mailing Address - Fax:801-337-1104
Practice Address - Street 1:1900 WASHINGTON BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-6850
Practice Address - Country:US
Practice Address - Phone:801-612-1085
Practice Address - Fax:801-337-1104
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7387085-1202111N00000X
UT7387085-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor