Provider Demographics
NPI:1033745047
Name:CROWDER, FELISTIA NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:FELISTIA
Middle Name:NICOLE
Last Name:CROWDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 QUEEN ANNE COLONEY
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1729
Mailing Address - Country:US
Mailing Address - Phone:304-545-6459
Mailing Address - Fax:
Practice Address - Street 1:116 MATTHEW DR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8418
Practice Address - Country:US
Practice Address - Phone:724-439-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD482027208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program