Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | R3158 | TX |
N | 208000000X | Pediatrician | 34.011345 | OH |
NPI | 1659699346 |
---|---|
Provider Name | Stephanie Felton |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2010 |
Last Update Date | 06/05/2021 |