Provider Demographics
NPI:1538819792
Name:BLACKSTON-JOHNSON, FELECIA NICOLE
Entity type:Individual
Prefix:MRS
First Name:FELECIA
Middle Name:NICOLE
Last Name:BLACKSTON-JOHNSON
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 1:5566 WESTOWER DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-2706
Mailing Address - Country:US
Mailing Address - Phone:804-316-2671
Mailing Address - Fax:
Practice Address - Street 1:5566 WESTOWER DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-2706
Practice Address - Country:US
Practice Address - Phone:804-316-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula