Provider Demographics
NPI:1619694767
Name:WILSON, FELICIA MARIE (BSN, RN, CHPN, CHM)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:BSN, RN, CHPN, CHM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 HOSPICE LN
Mailing Address - Street 2:
Mailing Address - City:KEARNEYSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25430-4547
Mailing Address - Country:US
Mailing Address - Phone:304-264-0407
Mailing Address - Fax:304-264-0409
Practice Address - Street 1:330 HOSPICE LN
Practice Address - Street 2:
Practice Address - City:KEARNEYSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25430-4547
Practice Address - Country:US
Practice Address - Phone:304-264-0407
Practice Address - Fax:304-264-0409
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR256933163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice