Provider Demographics
NPI:1912378332
Name:FELKINS, TAERA YOUNG (PA-C)
Entity Type:Individual
Prefix:
First Name:TAERA
Middle Name:YOUNG
Last Name:FELKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4062 GARFIELD ST
Mailing Address - Street 2:APARTMENT C
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7402
Mailing Address - Country:US
Mailing Address - Phone:760-277-1958
Mailing Address - Fax:
Practice Address - Street 1:605 CROUCH ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4415
Practice Address - Country:US
Practice Address - Phone:760-757-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA52859363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical