Healthcare Provider Details

I. General information

NPI: 1639543721
Provider Name (Legal Business Name): ALISHA J. KOLLE CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 GOVERNORS DR SW
HUNTSVILLE AL
35801-5126
US

IV. Provider business mailing address

28765 AL HIGHWAY 53
ARDMORE AL
35739-8709
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-0833
  • Fax: 256-533-0833
Mailing address:
  • Phone: 256-777-6310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number20732
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-132523
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: