Healthcare Provider Details

I. General information

NPI: 1033145982
Provider Name (Legal Business Name): FELICIA L. HARVEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11642 WEST FLORISSANT
ST. LOUIS MO
63033
US

IV. Provider business mailing address

5701 DELMAR BLVD
ST. LOUIS MO
63112-0937
US

V. Phone/Fax

Practice location:
  • Phone: 314-838-8220
  • Fax: 314-838-8091
Mailing address:
  • Phone: 314-367-7848
  • Fax: 314-367-5608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2001023410
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: