MEDICARE: FELICE IKE FNP-C

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	126099	WV
2	363LF0000X	Family Nurse Practitioner	5024579	NC
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN227751	GA
4	363L00000X	Nurse Practitioner	41324	TN
5	363L00000X	Nurse Practitioner	337516	AZ
6	363LF0000X	Family Nurse Practitioner	RN227751	GA
7	363L00000X	Nurse Practitioner	RN227751	GA
8	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	337516	AZ
9	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5024579	NC
10	363LF0000X	Family Nurse Practitioner	126099	WV
11	363LF0000X	Family Nurse Practitioner	41324	TN
12	363LF0000X	Family Nurse Practitioner	337516	AZ
13	363L00000X	Nurse Practitioner	126099	WV
14	363L00000X	Nurse Practitioner	5024579	NC
15	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	41324	TN

General Provider Information

NPI Number	:	1437625860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICE IKE FNP-C

Provider Business Mailing Address
First Line	:	2725 MARLIN DR
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6686
Country	:	US
Telephone Number	:	229-630-7442
Fax Number	:

Provider Business Practice Location Address
First Line	:	2725 MARLIN DR
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6686
Country	:	US
Telephone Number	:	229-630-7442
Fax Number	:

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

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	06/01/2026

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