| NPI | 1588164610 |
|---|---|
| Former Name | KELLIE MARIE PHELPS |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.017042) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209017042) |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2025-01-17 |