Healthcare Provider Details

I. General information

NPI: 1922234566
Provider Name (Legal Business Name): FELICIA ANN WHITEMAN PH.D., M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FELICIA ANN OWEN PH.D., M.P.

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 CAREY ST
SLIDELL LA
70458-3627
US

IV. Provider business mailing address

2331 CAREY ST
SLIDELL LA
70458-3627
US

V. Phone/Fax

Practice location:
  • Phone: 985-646-6406
  • Fax: 985-646-6460
Mailing address:
  • Phone: 985-646-6406
  • Fax: 985-646-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMP.0007
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMPAP.00044
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: