Healthcare Provider Details

I. General information

NPI: 1659670966
Provider Name (Legal Business Name): ALISHA RENEE HIGHTOWER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISHA RENEE FAULKNER APRN

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 PARK AVE
IRONTON OH
45638-1596
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-1100
  • Fax: 740-534-0029
Mailing address:
  • Phone: 606-408-6200
  • Fax: 606-408-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006879
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.12138
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: