Individual
JESSICA LOPEZ PHELPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1350 E MAIN ST STE 5, BARTOW, FL 33830-5065
(866) 234-8534
Mailing address
47 5TH ST NW, WINTER HAVEN, FL 33881-4672
(866) 234-8534
(863) 837-4469
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME174347
FL
2080A0000X
Pediatric Adolescent Medicine Physician
01059534A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200500370
—
IN
Enumeration date
02/08/2007
Last updated
05/21/2025
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