Individual
FELICIA FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1870 S BOULDER AVE, TULSA, OK 74119-5234
(918) 585-1213
(918) 585-1263
Mailing address
1870 S BOULDER AVE, TULSA, OK 74119-5234
(918) 585-1213
(918) 585-1263
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5FKF76
ICIS
OK
Enumeration date
09/02/2009
Last updated
09/03/2009
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