MEDICARE: MR. FELICIA ANN MANNING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	20896	OK

General Provider Information

NPI Number	:	1427355692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FELICIA ANN MANNING

Provider Business Mailing Address
First Line	:	10000 SE 55TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73150-4500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8320 NE 10TH ST
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7155
Country	:	US
Telephone Number	:	405-455-2139
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	02/23/2011

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