Provider Demographics
NPI:1639993512
Name:PHELPS, MISSTY LYN (RN)
Entity type:Individual
Prefix:
First Name:MISSTY
Middle Name:LYN
Last Name:PHELPS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1574
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78156-8574
Mailing Address - Country:US
Mailing Address - Phone:830-282-9202
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1574
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78156-8574
Practice Address - Country:US
Practice Address - Phone:830-282-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1074905163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health