Provider Demographics
NPI:1568110435
Name:CHADWELL, FELISHA PAIGE (SRNA)
Entity Type:Individual
Prefix:MRS
First Name:FELISHA
Middle Name:PAIGE
Last Name:CHADWELL
Suffix:
Gender:F
Credentials:SRNA
Other - Prefix:MS
Other - First Name:FELISHA
Other - Middle Name:PAIGE
Other - Last Name:MCGOWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SRNA
Mailing Address - Street 1:PO BOX 3044
Mailing Address - Street 2:
Mailing Address - City:WEST SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42564-3044
Mailing Address - Country:US
Mailing Address - Phone:606-687-2038
Mailing Address - Fax:606-200-3654
Practice Address - Street 1:200 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:606-687-2038
Practice Address - Fax:606-200-3654
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50186437376K00000X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No376K00000XNursing Service Related ProvidersNurse's Aide