Healthcare Provider Details

I. General information

NPI: 1346007481
Provider Name (Legal Business Name): FELICIA M COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 BRIARWOOD DR STE 108G
JACKSON MS
39206-3032
US

IV. Provider business mailing address

164 SWEETBRIAR CIR
CANTON MS
39046-8055
US

V. Phone/Fax

Practice location:
  • Phone: 601-761-1944
  • Fax:
Mailing address:
  • Phone: 662-299-1528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: