Healthcare Provider Details

I. General information

NPI: 1194095364
Provider Name (Legal Business Name): MRS. FELICIA RENEE PEARCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 N D ST
MCALESTER OK
74501-2314
US

IV. Provider business mailing address

307 W TURNPIKE RD
MCALESTER OK
74501-2580
US

V. Phone/Fax

Practice location:
  • Phone: 918-426-1614
  • Fax:
Mailing address:
  • Phone: 918-429-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: