Healthcare Provider Details

I. General information

NPI: 1003741455
Provider Name (Legal Business Name): FELICIA GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 ELLEN ST
CLINTON NC
28328-3202
US

IV. Provider business mailing address

216 ELLEN ST
CLINTON NC
28328-3202
US

V. Phone/Fax

Practice location:
  • Phone: 910-305-8102
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number61434
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: