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Individual

MRS. AMANDA R PHELPS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3217 MABEL ST, SHREVEPORT, LA 71103-4022
(318) 631-9121
(318) 631-9126
Mailing address
3217 MABEL ST, SHREVEPORT, LA 71103-4022
(318) 631-9121
(318) 631-9126

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
324297
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2539141
LA
01
324297
PHYSICIAN ASSISTANT LICENSURE
LA
Enumeration date
09/10/2020
Last updated
09/15/2022
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