Healthcare Provider Details

I. General information

NPI: 1336515659
Provider Name (Legal Business Name): ALISSA HOWARD REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISSA HOWARD REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 HIGHLAND KNOLL DR
CHARLOTTE NC
28269-3574
US

IV. Provider business mailing address

11 UNION ST S STE 314
CONCORD NC
28025-5059
US

V. Phone/Fax

Practice location:
  • Phone: 704-281-9928
  • Fax:
Mailing address:
  • Phone: 704-281-9928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number291687
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number667572
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number667572
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number667572
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number667572
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: