Provider Demographics
NPI:1497768451
Name:ABDELFATTAH, FELECIA GAIL (APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:FELECIA
Middle Name:GAIL
Last Name:ABDELFATTAH
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:26 MIDWAY STREET
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-989-4500
Practice Address - Fax:423-989-4582
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7668363L00000X
VALNP24164353363L00000X
VARN0001086415363L00000X
VA0017137018363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3349063Medicaid
334969OtherVALUE OPTIONS
351654200OtherDOL WORKERS COMP
620582605OtherHIGHLANDS WELLMONT
620582605OtherTRICARE SOUTH
188508OtherCOMPSYCH
TN3729687Medicaid
620582605OtherPHCS
620582605BEOtherUBH JOHN DEERE
620582605OtherMENTAL HEALTH NETW
620582605OtherINITIAL GROUP
620582605OtherTHREE RIVERS PROVI
TN3729687Medicaid
620582605OtherPHCS
334969OtherVALUE OPTIONS
TN3349063Medicare ID - Type Unspecified
TN3349063Medicaid