Individual
KELLY L PHELPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
117 E CLARK ST, HARRISBURG, IL 62946-2702
(618) 252-8625
(618) 252-2540
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
(618) 529-0586
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085001033
IL
Other
Enumeration date
05/04/2006
Last updated
02/16/2021
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