Individual
SHONDA JACQUELINE PHELON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.F.N.P.; P.M.H.N.P
Contact information
Practice address
1970 GRANDVIEW DR, GRENADA, MS 38901-5066
(662) 227-3700
(662) 227-3740
Mailing address
PO BOX 1505, GREENWOOD, MS 38935-1505
(662) 453-6211
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R734347
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R734347
MS
Other
Enumeration date
05/03/2007
Last updated
02/02/2010
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