Provider Demographics
NPI:1346992740
Name:PHELPS, PRISCILLA RASHELLE (APRN)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:RASHELLE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:RASHELLE
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1145 S UTICA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4013
Mailing Address - Country:US
Mailing Address - Phone:918-579-3825
Mailing Address - Fax:
Practice Address - Street 1:220 S ELM ST # 101
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3701
Practice Address - Country:US
Practice Address - Phone:918-403-7146
Practice Address - Fax:918-403-7169
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106811363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner