Provider Demographics
NPI:1548654536
Name:VINSON, FELICIA MICHELLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:MICHELLE
Last Name:VINSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 WALNUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-6619
Mailing Address - Country:US
Mailing Address - Phone:478-257-6033
Mailing Address - Fax:478-742-1707
Practice Address - Street 1:141 WALNUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-6619
Practice Address - Country:US
Practice Address - Phone:478-257-6033
Practice Address - Fax:478-742-1707
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN053555164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse