Provider Demographics
NPI:1295328102
Name:CHRETIEN, FELICIA NICHOLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:NICHOLE
Last Name:CHRETIEN
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 1:668 W BRAZOS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:TX
Mailing Address - Zip Code:77486-2616
Mailing Address - Country:US
Mailing Address - Phone:799-345-2525
Mailing Address - Fax:979-345-2601
Practice Address - Street 1:1525 N BROOKS ST
Practice Address - Street 2:
Practice Address - City:BRAZORIA
Practice Address - State:TX
Practice Address - Zip Code:77422-5719
Practice Address - Country:US
Practice Address - Phone:979-345-2525
Practice Address - Fax:979-345-2601
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX620923363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner