Provider Demographics
NPI:1740947779
Name:STEWART, FELICIA (LPN)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-5239
Mailing Address - Country:US
Mailing Address - Phone:865-640-1187
Mailing Address - Fax:865-630-0109
Practice Address - Street 1:2617 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-5239
Practice Address - Country:US
Practice Address - Phone:865-640-1187
Practice Address - Fax:865-630-0109
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50957164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty