Healthcare Provider Details

I. General information

NPI: 1760804355
Provider Name (Legal Business Name): FELICIA ANN THOMPSON COBURN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 WALNUT GROVE RD
MEMPHIS TN
38120-2113
US

IV. Provider business mailing address

8243 HOLSTON DR
MEMPHIS TN
38125-3982
US

V. Phone/Fax

Practice location:
  • Phone: 901-701-5825
  • Fax: 901-767-6591
Mailing address:
  • Phone: 901-483-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18928
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209010853
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0000018928
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: