Jennifer Pearl Phelps

Primary specialty

Emergency Registered NurseTaxonomy code 163WE0003X

License

1536926 Issued in MN

Practice address

10246 Bollenbacher Rd
Brainerd, MN 56401-5932

Phone

(612) 327-7623

NPI assigned

Jan 5, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641340800000",
    "number": "1124789847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10246 BOLLENBACHER RD",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564015932",
            "telephone_number": "612-327-7623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10246 BOLLENBACHER RD",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564015932",
            "telephone_number": "612-327-7623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELPS",
        "first_name": "JENNIFER",
        "middle_name": "PEARL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-05",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "MN",
            "license": "1536926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Dawn Paul, PHYSICIAN ASSISTANT
• David Brian Paul, MD
• Peak Therapy Services
• Michelle Pelkey, RD
• Souksavanh Phaengkhouane, PHARM.D.
• Aby Zachariah Philip, MBBS
• Rebecca Ann Piekarski, PHARMD
• Cassie A Piepkorn, APRN,CNP
• Deanne Marie Pikula
• Angela Pitan

• Emergency Registered Nurse in Brainerd, MN
• Providers in Brainerd, MN by specialty
• Emergency Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.