Healthcare Provider Details

I. General information

NPI: 1972128718
Provider Name (Legal Business Name): MAYTE FEKETE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 HARTFORD HWY STE 1
DOTHAN AL
36305-4927
US

IV. Provider business mailing address

2812 HARTFORD HWY STE 1
DOTHAN AL
36305-4927
US

V. Phone/Fax

Practice location:
  • Phone: 334-712-1170
  • Fax: 334-460-8391
Mailing address:
  • Phone: 334-712-1170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number141070
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1-10145
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number163286
License Number StateAK
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-101045
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: