Healthcare Provider Details

I. General information

NPI: 1851753826
Provider Name (Legal Business Name): ALINA CUMMINS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E WALNUT LAWN
SPRINGFIELD MO
69580
US

IV. Provider business mailing address

PO BOX 4046
SPRINGFIELD MO
65808-4046
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-4450
  • Fax: 417-269-8333
Mailing address:
  • Phone: 417-269-5712
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2016006722
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: