Healthcare Provider Details

I. General information

NPI: 1497130306
Provider Name (Legal Business Name): FELICIA LYNELLE HARRELL AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 03/28/2023
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 MALLARD CREEK RD
CHARLOTTE NC
28262-9786
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-510-8000
  • Fax: 704-510-8006
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024172651
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024172651
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5008094
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: