MEDICARE: FELICITY WOMENS CENTER

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

General Provider Information

NPI Number	:	1629855051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FELICITY WOMENS CENTER

Provider Business Mailing Address
First Line	:	12587 S FORT ST STE 202
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-9404
Country	:	US
Telephone Number	:	801-893-9564
Fax Number	:	801-893-9062

Provider Business Practice Location Address
First Line	:	12587 S FORT ST STE 202
Second Line	:
City	:	DRAPER
State	:	UT
Zip	:	84020-9404
Country	:	US
Telephone Number	:	801-893-9564
Fax Number	:	801-893-9062

Authorized Official
Title or Position	:	PSYCHIATRIC-MENTAL HEALTH NURSE PRA
Name	:	ALLYCE KATIE JONES
Credential	:	PMHNP
Telephone Number	:	801-893-9564

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	09/11/2023

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