1770811960 NPI number — FELISA Y NORTHERN RN, MSN, FNP, PMHNP

Table of content: FELISA Y NORTHERN RN, MSN, FNP, PMHNP (NPI 1770811960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770811960 NPI number — FELISA Y NORTHERN RN, MSN, FNP, PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORTHERN
Provider First Name:
FELISA
Provider Middle Name:
Y
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, FNP, PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770811960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 REYNOLDSBURG NEW ALBANY RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLACKLICK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43004-3608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-500-1792
Provider Business Mailing Address Fax Number:
614-604-6103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 REYNOLDSBURG NEW ALBANY RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACKLICK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43004-3608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-500-1792
Provider Business Practice Location Address Fax Number:
833-740-3705
Provider Enumeration Date:
11/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN.CNP.13069 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X , with the licence number: APRN.CNP.13069 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3015383 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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