Provider Demographics
NPI:1497187512
Name:KEYS, FELICIA (NP-C)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:KEYS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W 1ST SUITE C SUITE C
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440
Mailing Address - Country:US
Mailing Address - Phone:601-274-4004
Mailing Address - Fax:601-374-6884
Practice Address - Street 1:1250 W 1ST SUITE C
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4312
Practice Address - Country:US
Practice Address - Phone:601-274-4004
Practice Address - Fax:601-374-6884
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134037363LP0808X
MSR876242363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSR876242OtherLICENSE