Provider Demographics
NPI:1487153508
Name:MAHER, FELICIA KAYE (RN)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:KAYE
Last Name:MAHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:
Other - Last Name:JEFFERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8609 W STONEY CREEK ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-8420
Mailing Address - Country:US
Mailing Address - Phone:940-781-6916
Mailing Address - Fax:
Practice Address - Street 1:4245 KEMP BLVD STE 720
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2833
Practice Address - Country:US
Practice Address - Phone:940-781-6916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-04
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN236270163WA0400X
CA95135099163WP0808X
TX1121328363LP0808X
TX642551163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse