Provider Demographics
NPI:1952354367
Name:KNOWLES, FELICIA MERRIWEATHER
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:MERRIWEATHER
Last Name:KNOWLES
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 1:1615 SADDLE GLEN CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-6198
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2182 WEST ST
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3829
Practice Address - Country:US
Practice Address - Phone:901-759-7977
Practice Address - Fax:901-759-4919
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN341922080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3495416Medicaid
620903564OtherVESTICA/OMNICARE
AR152568001Medicaid
1985672OtherUNITED HEALTHCARE
TN4069414OtherBCBS OF TENNESSEE
MS02926210Medicaid
3461406OtherCIGNA
30928OtherTLC
7501110OtherAETNA
MS02926210Medicaid