Provider Demographics
NPI:1376596700
Name:FELTEN, SUSAN K (APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:FELTEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:305 KEENE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6897
Practice Address - Country:US
Practice Address - Phone:573-882-8000
Practice Address - Fax:573-882-6600
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO064596363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO527875OtherHEALTHLINK
MO425387404Medicaid
MO172633OtherBLUE SHIELD/BLUE CHOICE
P36938Medicare UPIN
MO425387404Medicaid
MO023080010Medicare PIN
MO172633OtherBLUE SHIELD/BLUE CHOICE
MO834275236Medicare UPIN