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General NPI Number Information
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NPI Number | 1609272509
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Entity Type | Individual
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Provider Name | ALISHA DEVAUN AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 4215 JOE RAMSEY BLVD E
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City | GREENVILLE
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State | TX
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Zip | 75401-7852
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Country | US
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Telephone | 903-450-3543
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Fax |
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Provider Business Mailing Address
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Address Line | 9792 SHAWNEE LN
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City | QUINLAN
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State | TX
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Zip | 75474-3720
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Country | US
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Telephone | 903-450-3543
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP126839
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License Number State | TX
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