Provider Demographics
NPI:1942694260
Name:DANIEL, FELICIA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 LAKE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5809
Mailing Address - Country:US
Mailing Address - Phone:662-542-9504
Mailing Address - Fax:
Practice Address - Street 1:305 HIGHWAY 346
Practice Address - Street 2:
Practice Address - City:ECRU
Practice Address - State:MS
Practice Address - Zip Code:38841-9772
Practice Address - Country:US
Practice Address - Phone:662-489-2669
Practice Address - Fax:662-489-2670
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19764363LF0000X
MS902272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6085670OtherBLUE CROSS BLUE SHIELD
TNQ020650Medicaid