Healthcare Provider Details

I. General information

NPI: 1649251448
Provider Name (Legal Business Name): ALISA J CLICK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 SLATE AVE
OWINGSVILLE KY
40360-2206
US

IV. Provider business mailing address

PO BOX 1120
OWINGSVILLE KY
40360-1120
US

V. Phone/Fax

Practice location:
  • Phone: 606-674-6386
  • Fax: 606-674-3096
Mailing address:
  • Phone: 606-674-6386
  • Fax: 606-674-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3814P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: