Basic Information
| Provider Information | |||||||||
| NPI: | 1952913931 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DODD | ||||||||
| FirstName: | FELICIA | ||||||||
| MiddleName: | LOREN | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 LARKIN DR | ||||||||
| Address2: | |||||||||
| City: | MARTIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 382372326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315144034 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8598 HIGHWAY 22 | ||||||||
| Address2: | |||||||||
| City: | DRESDEN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 382252308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7313645675 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2020 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 28795 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | Q064528 | 05 | TN | MEDICAID |