Provider Demographics
NPI:1114442340
Name:WORTHEN, FELICIA MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:MICHELLE
Last Name:WORTHEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 VETERANS PKWY STE G
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2525
Mailing Address - Country:US
Mailing Address - Phone:706-221-5084
Mailing Address - Fax:706-221-5076
Practice Address - Street 1:7500 VETERANS PKWY STE G
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2525
Practice Address - Country:US
Practice Address - Phone:706-221-5084
Practice Address - Fax:706-221-5076
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF07171293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF07171293OtherAANP