Provider Demographics
NPI:1447679899
Name:RICHARDSON, FELECIA RENEE' (RN-BSN)
Entity type:Individual
Prefix:MRS
First Name:FELECIA
Middle Name:RENEE'
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 HIGHWAY 905
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-6831
Mailing Address - Country:US
Mailing Address - Phone:843-333-9759
Mailing Address - Fax:
Practice Address - Street 1:1409 HIGHWAY 905
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-6831
Practice Address - Country:US
Practice Address - Phone:843-333-9759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC75834163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse