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Organization
PHELPS FAMILY PRACTICE, PLLC
Active
Organization
PHELPS FAMILY PRACTICE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANNON BARDIN PHELPS F.N.P. (OWNER)
(910) 842-2443
Entity
Organization
Contact information
Practice address
204 SMITH AVE, SHALLOTTE, NC 28470-4458
(910) 842-2443
Mailing address
PO BOX 1369, SHALLOTTE, NC 28459-1369
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201344
APPROVAL NUMBER,BOM
NC
Enumeration date
06/25/2007
Last updated
03/07/2023
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