Healthcare Provider Details

I. General information

NPI: 1942654074
Provider Name (Legal Business Name): PROF. FELICIA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FDB HAIR UNLIMITED LLC

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 N HANLEY RD
SAINT LOUIS MO
63114-6309
US

IV. Provider business mailing address

2610 SAINT VINCENT AVE
SAINT LOUIS MO
63104-2028
US

V. Phone/Fax

Practice location:
  • Phone: 314-504-6466
  • Fax:
Mailing address:
  • Phone: 314-504-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberLC0665509
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: