Provider Demographics
NPI:1467575662
Name:BRICKEY, FELICIA J (FNP)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:J
Last Name:BRICKEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:J
Other - Last Name:TITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:2421 N JOHN B DENNIS HWY
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4773
Practice Address - Country:US
Practice Address - Phone:423-288-3988
Practice Address - Fax:423-288-3273
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN12698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103500I908Medicare PIN
TN33411261Medicare PIN