Provider Demographics
NPI:1316772775
Name:ALLSUP, ALESHA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:ALESHA
Middle Name:MARIE
Last Name:ALLSUP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALESHA
Other - Middle Name:MARIE
Other - Last Name:GAUNTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3200 RIVERFRONT DR STE 207
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6534
Mailing Address - Country:US
Mailing Address - Phone:817-882-6754
Mailing Address - Fax:
Practice Address - Street 1:3200 RIVERFRONT DR STE 207
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6534
Practice Address - Country:US
Practice Address - Phone:817-882-6754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1172657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily