Provider Demographics
NPI:1750844494
Name:THOMAS, FELICIA LATICE (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:LATICE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 KANDILA TRL
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-9700
Mailing Address - Country:US
Mailing Address - Phone:318-294-4183
Mailing Address - Fax:
Practice Address - Street 1:8731 PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5682
Practice Address - Country:US
Practice Address - Phone:318-797-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP10118363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2646002OtherWELLCARE
4967547OtherAETNA
175314OtherVANTAGE
3418139OtherFIRST HEALTH
13766640OtherMULTIPLAN (PHCS)
LAPDZ000000314926OtherAETNA BETTER HEALTH
LA2500236Medicaid
3418715OtherCIGNA
LA60425845OtherAMERIHEALTH CARITAS