Healthcare Provider Details

I. General information

NPI: 1326862202
Provider Name (Legal Business Name): ALISHA EADS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 BURKESVILLE ST STE 101
COLUMBIA KY
42728-1900
US

IV. Provider business mailing address

203 BURKESVILLE ST STE 101
COLUMBIA KY
42728-1900
US

V. Phone/Fax

Practice location:
  • Phone: 270-250-5070
  • Fax: 270-380-1711
Mailing address:
  • Phone: 270-250-5070
  • Fax: 270-380-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: