Healthcare Provider Details

I. General information

NPI: 1306006002
Provider Name (Legal Business Name): FELICIA E. HOLSTON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 FRANKLIN SQ
BONAIRE GA
31005-3244
US

IV. Provider business mailing address

103 FRANKLIN SQ
BONAIRE GA
31005-3244
US

V. Phone/Fax

Practice location:
  • Phone: 478-396-0506
  • Fax:
Mailing address:
  • Phone: 478-396-0506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberP05580
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: