Carol Phelan, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F332976 Issued in NY

Practice address

10 Century Hill Dr
Latham, NY 12110-2162

Phone

(518) 783-5563

Fax

(518) 785-5708

NPI assigned

Sep 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shaker Pediatrics PC

  • Pediatric Adolescent Medicine Physician
  • Latham, NY
  • NPI 1336156223
  NPD (past)

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790881886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 CENTURY HILL DR",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102162",
            "telephone_number": "518-783-5563",
            "fax_number": "518-785-5708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 CENTURY HILL DR",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102162",
            "telephone_number": "518-783-5563",
            "fax_number": "518-785-5708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELAN",
        "first_name": "CAROL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F332976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "696215",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02351908",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Petitti
• Petsche Psychology Practice, PLLC
• Andrew Petsche, PHD
• Caroline Peyron
• Nia T Pham
• Barbara Hepworth Phelps, OTR
• Carlton Phelps
• Colleen Phillips
• Physical Therapy Associates of Schenectady, P.C.
• Allison Piekara

• Family Nurse Practitioner in Latham, NY
• Providers in Latham, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.