Healthcare Provider Details

I. General information

NPI: 1932650140
Provider Name (Legal Business Name): FELICIA MORRIS OMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FELICIA ROSS RDH

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E SECOND ST FL 2
PASS CHRISTIAN MS
39571-4442
US

IV. Provider business mailing address

15503 OAK LN STE 300-B
GULFPORT MS
39503-2697
US

V. Phone/Fax

Practice location:
  • Phone: 228-493-1366
  • Fax: 228-832-0186
Mailing address:
  • Phone: 228-832-3231
  • Fax: 228-832-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3869-10DH
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: