Individual
MRS. KATHY DIANNE PHELPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN FNP
Contact information
Practice address
3131 PARISA DR, PADUCAH, KY 42003-4584
(270) 444-8000
(270) 444-8302
Mailing address
PO BOX 1175, CALVERT CITY, KY 42029
(270) 395-5388
(270) 395-1792
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3143P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000340382
ANTHEM
—
05
—
78015690
—
KY
Enumeration date
10/10/2006
Last updated
12/07/2012
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