Healthcare Provider Details

I. General information

NPI: 1205455367
Provider Name (Legal Business Name): FELICIA M MCDONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 S MCPHERSON CHURCH RD STE 103B
FAYETTEVILLE NC
28303-5383
US

IV. Provider business mailing address

951 S MCPHERSON CHURCH RD STE 103B
FAYETTEVILLE NC
28303-5383
US

V. Phone/Fax

Practice location:
  • Phone: 910-339-3008
  • Fax:
Mailing address:
  • Phone: 910-339-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: