Provider Demographics
NPI:1962080705
Name:LAYSSARD, FELICIA
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:LAYSSARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14225 WINDY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-2176
Mailing Address - Country:US
Mailing Address - Phone:713-960-3128
Mailing Address - Fax:
Practice Address - Street 1:4806 WEST WALNUT STREET
Practice Address - Street 2:200
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581
Practice Address - Country:US
Practice Address - Phone:713-960-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX704034163WH0200X
TX778632163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX778632OtherRN LICENCE