Provider Demographics
NPI:1497768451
Name:ABDELFATTAH, FELECIA GAIL (APRN BC)
Entity type:Individual
Prefix:MRS
First Name:FELECIA
Middle Name:GAIL
Last Name:ABDELFATTAH
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:1145 VOLUNTEER PKWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4652
Practice Address - Country:US
Practice Address - Phone:423-989-4500
Practice Address - Fax:423-989-4582
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164353363LF0000X
TN7668363LF0000X
VARN0001086415363L00000X
VA0017137018363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3349063Medicaid
351654200OtherDOL WORKERS COMP
620582605OtherINITIAL GROUP
620582605OtherMENTAL HEALTH NETW
334969OtherVALUE OPTIONS
620582605BEOtherUBH JOHN DEERE
620582605OtherPHCS
TN3729687Medicaid
620582605OtherTHREE RIVERS PROVI
620582605OtherTRICARE SOUTH
620582605OtherHIGHLANDS WELLMONT
188508OtherCOMPSYCH
TN3729687Medicaid
620582605OtherPHCS
334969OtherVALUE OPTIONS
TN3349063Medicare ID - Type Unspecified
TN3349063Medicaid