Provider Demographics
NPI:1316401029
Name:WARREN, FELECIA DENICE (FNP)
Entity Type:Individual
Prefix:
First Name:FELECIA
Middle Name:DENICE
Last Name:WARREN
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 1:3700 S RAILROAD ST STE B
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-2994
Mailing Address - Country:US
Mailing Address - Phone:334-298-7700
Mailing Address - Fax:866-537-1711
Practice Address - Street 1:475 CANTERBURY FARM RD
Practice Address - Street 2:
Practice Address - City:MIDLAND CITY
Practice Address - State:AL
Practice Address - Zip Code:36350-5205
Practice Address - Country:US
Practice Address - Phone:334-983-1934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-27
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF01190203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily