Provider Demographics
NPI:1801579057
Name:MCKNIGHT GRAY, FELICIA TEONA
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:TEONA
Last Name:MCKNIGHT GRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 POAG ST APT 2122
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-2463
Mailing Address - Country:US
Mailing Address - Phone:703-656-0722
Mailing Address - Fax:
Practice Address - Street 1:2803 POAG ST APT 2122
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-2463
Practice Address - Country:US
Practice Address - Phone:703-656-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide