Healthcare Provider Details

I. General information

NPI: 1356951149
Provider Name (Legal Business Name): ALISHA KAY PREVOST PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 10/27/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 S 8TH ST
BEAUMONT TX
77701-7719
US

IV. Provider business mailing address

105 CANYON LAKE CIR
LUMBERTON TX
77657-3701
US

V. Phone/Fax

Practice location:
  • Phone: 409-839-1000
  • Fax:
Mailing address:
  • Phone: 409-200-2220
  • Fax: 409-440-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1077025
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: