Healthcare Provider Details

I. General information

NPI: 1851121297
Provider Name (Legal Business Name): ALICA CARYNN BRISTER RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 COLISEUM BLVD
ALEXANDRIA LA
71303-3676
US

IV. Provider business mailing address

5604 COLISEUM BLVD
ALEXANDRIA LA
71303-3676
US

V. Phone/Fax

Practice location:
  • Phone: 318-487-5282
  • Fax:
Mailing address:
  • Phone: 318-487-5282
  • Fax: 318-487-5330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number204523
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: