Provider Demographics
NPI:1346424884
Name:DYESS, FELICIA M (AP)
Entity Type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:M
Last Name:DYESS
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4692 CAMP CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2666
Mailing Address - Country:US
Mailing Address - Phone:904-240-5927
Mailing Address - Fax:
Practice Address - Street 1:12428 SAN JOSE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8617
Practice Address - Country:US
Practice Address - Phone:904-240-5927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2485171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist