Provider Demographics
NPI:1760695522
Name:FELTON, CORTNEY L
Entity Type:Individual
Prefix:
First Name:CORTNEY
Middle Name:L
Last Name:FELTON
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:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26280
Mailing Address - Country:US
Mailing Address - Phone:304-335-6777
Mailing Address - Fax:304-335-6779
Practice Address - Street 1:HC 58 SUITE 352Y
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WV
Practice Address - Zip Code:26280-3394
Practice Address - Country:US
Practice Address - Phone:304-335-6777
Practice Address - Fax:304-335-6779
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002529174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist