Provider Demographics
NPI:1063404309
Name:SCHRICKEL FELLER, TRISTA KAY (MD)
Entity type:Individual
Prefix:DR
First Name:TRISTA
Middle Name:KAY
Last Name:SCHRICKEL FELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRISTA
Other - Middle Name:KAY
Other - Last Name:SCHRICKEL FELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1505 PATRICIA DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8648
Mailing Address - Country:US
Mailing Address - Phone:614-229-0715
Mailing Address - Fax:
Practice Address - Street 1:150 MOREY DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1646
Practice Address - Country:US
Practice Address - Phone:937-644-2541
Practice Address - Fax:937-642-7535
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085544207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2573362Medicaid
OH2573362Medicaid
OHSC4160221Medicare ID - Type Unspecified