Healthcare Provider Details

I. General information

NPI: 1689151979
Provider Name (Legal Business Name): FELICIA ADRIA BENSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 383C
SAINT LOUIS MO
63131-2324
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-7014
  • Fax: 314-273-0140
Mailing address:
  • Phone: 314-996-7014
  • Fax: 314-273-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2018022118
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018022118
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: