Healthcare Provider Details

I. General information

NPI: 1336009620
Provider Name (Legal Business Name): ALISHA NOBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 BETHANY AVE
BETHANY MO
64424-8363
US

IV. Provider business mailing address

5281 290TH ST
ALBANY MO
64402-8165
US

V. Phone/Fax

Practice location:
  • Phone: 660-425-6324
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number2010002291
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: