Healthcare Provider Details

I. General information

NPI: 1417851791
Provider Name (Legal Business Name): KATHERINE FEAGAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N COURTENAY PKWY
MERRITT ISLAND FL
32953-3456
US

IV. Provider business mailing address

322 TROTTERS ST
PALM BAY FL
32909-1117
US

V. Phone/Fax

Practice location:
  • Phone: 321-633-3162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11051401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: