MEDICARE: FELICIA MICHELLE WORTHEN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F07171293	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F07171293	OTHER	GA	AANP

General Provider Information

NPI Number	:	1114442340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICIA MICHELLE WORTHEN FNP

Provider Business Mailing Address
First Line	:	7500 VETERANS PKWY STE G
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-2525
Country	:	US
Telephone Number	:	706-221-5084
Fax Number	:	706-221-5076

Provider Business Practice Location Address
First Line	:	7500 VETERANS PKWY STE G
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-2525
Country	:	US
Telephone Number	:	706-221-5084
Fax Number	:	706-221-5076

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2017
Last Update Date	:	08/02/2023

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