Provider Demographics
NPI:1407377427
Name:BAREFIELD, FELICIA RENEE
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:RENEE
Last Name:BAREFIELD
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 1:1222 VERNON DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-5714
Mailing Address - Country:US
Mailing Address - Phone:937-245-0128
Mailing Address - Fax:
Practice Address - Street 1:1222 VERNON DRIVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402
Practice Address - Country:US
Practice Address - Phone:937-245-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH437827163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid
$$$$$$$$$OtherTIN