Healthcare Provider Details

I. General information

NPI: 1891699138
Provider Name (Legal Business Name): FELECIA PETERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 HOLT COLLIER DR
VICKSBURG MS
39183-4402
US

IV. Provider business mailing address

106 HOLT COLLIER DR
VICKSBURG MS
39183-4402
US

V. Phone/Fax

Practice location:
  • Phone: 601-738-5234
  • Fax: 601-738-5235
Mailing address:
  • Phone: 601-738-5234
  • Fax: 601-738-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberMS-19553-150272
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: