Individual
KHADIJAH LYNN PHELPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10628 PARK RD, CHARLOTTE, NC 28210-8407
(704) 667-1000
Mailing address
516 CRICKET CHIRP LN, ELGIN, SC 29045-8564
(803) 747-1518
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
261584
SC
363LF0000X
Family Nurse Practitioner
31864
SC
Other
Enumeration date
06/02/2025
Last updated
05/07/2026
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