Provider Demographics
NPI:1154019917
Name:BROWN, ALISHA NICOLE
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:NICOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 MAIN ST STE 122
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3603
Mailing Address - Country:US
Mailing Address - Phone:615-546-0876
Mailing Address - Fax:629-600-5755
Practice Address - Street 1:615 MAIN ST STE 122
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3603
Practice Address - Country:US
Practice Address - Phone:615-546-0876
Practice Address - Fax:629-600-5755
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN74285164W00000X
TN252Y00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No252Y00000XAgenciesEarly Intervention Provider Agency