Provider Demographics
NPI:1083377766
Name:CHRISTIAN, FELICIA
Entity Type:Individual
Prefix:MISS
First Name:FELICIA
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 BOONE RIDGE DR APT 216
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-5028
Mailing Address - Country:US
Mailing Address - Phone:865-293-9387
Mailing Address - Fax:
Practice Address - Street 1:133 BOONE RIDGE DR APT 216
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-5028
Practice Address - Country:US
Practice Address - Phone:865-293-9387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3916133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered