Provider Demographics
NPI:1376714311
Name:FELTS, LINDA ANN
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANN
Last Name:FELTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-1754
Mailing Address - Country:US
Mailing Address - Phone:817-594-0260
Mailing Address - Fax:817-594-3321
Practice Address - Street 1:119 N MAIN ST
Practice Address - Street 2:STE. 218
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-3257
Practice Address - Country:US
Practice Address - Phone:817-594-0260
Practice Address - Fax:817-594-3321
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CMF C36245335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1262060001Medicare PIN