Provider Demographics
NPI:1760284533
Name:THOMPSON-OUTLAW, FELICIA (PASTOR FELICIA)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:
Last Name:THOMPSON-OUTLAW
Suffix:
Gender:
Credentials:PASTOR FELICIA
Other - Prefix:MRS
Other - First Name:FELICIA
Other - Middle Name:
Other - Last Name:OUTLAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CHAPLAIN, PASTOR
Mailing Address - Street 1:PO BOX 1064
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-1064
Mailing Address - Country:US
Mailing Address - Phone:601-614-1476
Mailing Address - Fax:
Practice Address - Street 1:601 N 15TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-3839
Practice Address - Country:US
Practice Address - Phone:601-614-1476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker