Provider Demographics
NPI:1144077215
Name:TARLEY, FELICIA COUSEYON (CNA)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:COUSEYON
Last Name:TARLEY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4552 18TH ST S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-7188
Mailing Address - Country:US
Mailing Address - Phone:701-729-1634
Mailing Address - Fax:
Practice Address - Street 1:4552 18TH ST S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-7188
Practice Address - Country:US
Practice Address - Phone:701-729-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNG000-075-945-700251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health