Provider Demographics
NPI:1457846776
Name:THOMAS, FELICIA MARIE
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:MARIE
Last Name:THOMAS
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 1:2800 YOUREE DR STE 482
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3666
Mailing Address - Country:US
Mailing Address - Phone:318-869-1899
Mailing Address - Fax:
Practice Address - Street 1:2800 YOUREE DR STE 482
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3666
Practice Address - Country:US
Practice Address - Phone:318-869-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-28
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA$$$$$$$$$Medicaid