Healthcare Provider Details

I. General information

NPI: 1003696345
Provider Name (Legal Business Name): ALITA BILLOPS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 CORPORATE DR STE R
JOHNSTON IA
50131-1659
US

IV. Provider business mailing address

411 RYAN DR
FAIRVIEW HEIGHTS IL
62208-3728
US

V. Phone/Fax

Practice location:
  • Phone: 618-977-6292
  • Fax:
Mailing address:
  • Phone: 618-530-2378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2023040281
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number277005567
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberH177391
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: