Provider Demographics
NPI:1902395163
Name:SMITH, FELICIA OLUYEMISI
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:OLUYEMISI
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLUYEMISI
Other - Middle Name:FELICIA
Other - Last Name:ADETORO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11355 RICHMOND AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-7637
Mailing Address - Country:US
Mailing Address - Phone:832-576-0484
Mailing Address - Fax:
Practice Address - Street 1:11355 RICHMOND AVE APT 311
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-7637
Practice Address - Country:US
Practice Address - Phone:832-576-0484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX304159164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse