Khadijah Lynn Phelps

Primary specialty

Medical-Surgical Registered NurseTaxonomy code 163WM0705X

License

261584 Issued in SC

Practice address

10628 Park Rd
Charlotte, NC 28210-8407

Phone

(704) 667-1000

NPI assigned

Jun 2, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Commonwealth Pain Associates, PLLC

  • Interventional Pain Medicine Physician
  • Louisville, KY
  • NPI 1306280177

  Family, SC

  Medicare reassignment NPD
• Commonwealth Pain Associates PLLC

  • Durable Medical Equipment & Medical Supplies
  • Paducah, KY
  • NPI 1114753720
  NPD (past)

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

{
    "created_epoch": "1748822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778112000000",
    "number": "1972496636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 CRICKET CHIRP LN",
            "city": "ELGIN",
            "state": "SC",
            "postal_code": "290458564",
            "telephone_number": "803-747-1518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10628 PARK RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282108407",
            "telephone_number": "704-667-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "127 Ben Casey Dr Ste 103",
            "address_purpose": "LOCATION",
            "city": "Fort Mill",
            "state": "SC",
            "postal_code": "297086600",
            "country_code": "US",
            "telephone_number": "502-855-7200",
            "fax_number": "502-855-7201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7021 Saint Andrews Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292121177",
            "country_code": "US",
            "telephone_number": "803-791-7175",
            "fax_number": "803-791-7176",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1506 N Fant St",
            "address_purpose": "LOCATION",
            "city": "Anderson",
            "state": "SC",
            "postal_code": "296214708",
            "country_code": "US",
            "telephone_number": "864-260-6995",
            "fax_number": "864-884-9909",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "279 E Kennedy St",
            "address_purpose": "LOCATION",
            "city": "Spartanburg",
            "state": "SC",
            "postal_code": "293021912",
            "country_code": "US",
            "telephone_number": "864-583-0053",
            "fax_number": "864-583-0390",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10 Enterprise Blvd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296153554",
            "country_code": "US",
            "telephone_number": "864-295-6399",
            "fax_number": "864-295-2337",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9404 Highway 78 Ste 100",
            "address_purpose": "LOCATION",
            "city": "Ladson",
            "state": "SC",
            "postal_code": "294563909",
            "country_code": "US",
            "telephone_number": "502-855-7200",
            "fax_number": "502-855-7201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHELPS",
        "first_name": "KHADIJAH",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-02",
        "last_updated": "2026-05-07",
        "certification_date": "2026-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "SC",
            "license": "261584",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "31864",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Knasel Pheifer, RD
• Dermot Michael Phelan, MD
• Phelps DMD & Associates
• Jaryn Royce Phelps, AUD
• Kevin Daniel Phelps, MD
• Shelly Marie Luttman Phelps, LCSW
• Phenogen Sciences Inc.
• Varsha Laxman Pherwani, MD
• Debra Phifer-Smith
• Britney Mobley Phifer, LMFT

• Medical-Surgical Registered Nurse in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Medical-Surgical Registered Nurse in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.