Provider Demographics
NPI:1386537298
Name:WILSON, FELICIA
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-4179
Mailing Address - Country:US
Mailing Address - Phone:757-945-9337
Mailing Address - Fax:
Practice Address - Street 1:11815 FOUNTAIN WAY STE 300
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4448
Practice Address - Country:US
Practice Address - Phone:757-326-3621
Practice Address - Fax:757-844-6430
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0005233251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health