Provider Demographics
NPI:1760804355
Name:THOMPSON COBURN, FELICIA ANN (NP)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:ANN
Last Name:THOMPSON COBURN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8243 HOLSTON DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-3982
Mailing Address - Country:US
Mailing Address - Phone:901-483-2550
Mailing Address - Fax:
Practice Address - Street 1:6019 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2113
Practice Address - Country:US
Practice Address - Phone:901-701-5825
Practice Address - Fax:901-767-6591
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18928363LF0000X
IL209010853363LF0000X
TN0000018928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily