Individual
CAMILLE EUVON PHELPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
134 N 12TH AVE, DURANT, OK 74701-4718
(903) 820-9475
Mailing address
134 N 12TH AVE, DURANT, OK 74701-4718
(903) 820-9475
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407916802
—
OK
Enumeration date
04/28/2016
Last updated
04/28/2016
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