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General NPI Number Information
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NPI Number | 1336543305
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Entity Type | Individual
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Provider Name | ALICIA BRISTER CFNP
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Gender | Female
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 914 SUMRALL RD
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City | COLUMBIA
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State | MS
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Zip | 39429-2652
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Country | US
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Telephone | 601-731-1470
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Fax | 601-731-1474
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Provider Business Mailing Address
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Address Line | 37 POWELL GROVE RD
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City | JAYESS
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State | MS
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Zip | 39641-3610
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Country | US
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Telephone | 601-455-7234
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R857423
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License Number State | MS
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