Provider Demographics
NPI:1689151979
Name:BENSON, FELICIA ADRIA (APRN)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:ADRIA
Last Name:BENSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13655 RIVERPORT DR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-4812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13655 RIVERPORT DR
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-4812
Practice Address - Country:US
Practice Address - Phone:314-561-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018022118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily