Provider Demographics
NPI:1346230224
Name:FELTON, CAROL KK (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:KK
Last Name:FELTON
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 1:3601 4TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-8340
Mailing Address - Country:US
Mailing Address - Phone:806-743-2340
Mailing Address - Fax:806-743-3121
Practice Address - Street 1:3601 4TH ST FL 3
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0002
Practice Address - Country:US
Practice Address - Phone:806-743-2340
Practice Address - Fax:806-743-3121
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8696207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83026ZOtherHMO BLUE
NM52403Medicaid
NMA002OtherTRIWEST
TX115015302Medicaid
TX112596102Medicaid
TX89522GOtherBC/BS
NM52403OtherPRESBYTERIAN COMMERCIAL
OK100025190AMedicaid
TX112596101OtherFIRSTCARE COMMERCIAL
TX115015301Medicaid
NMT9575Medicaid