Provider Demographics
NPI:1558927129
Name:WILLIAMS, FELICIA D
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:D
Last Name:WILLIAMS
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 1:1249 BRENTHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-2411
Mailing Address - Country:US
Mailing Address - Phone:314-643-1861
Mailing Address - Fax:
Practice Address - Street 1:1249 BRENTHAVEN LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-2411
Practice Address - Country:US
Practice Address - Phone:314-643-1861
Practice Address - Fax:314-801-7730
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-19
Last Update Date:2019-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care