Provider Demographics
NPI:1528347168
Name:KLICK-DAVIS, ALISA (ARNP)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:KLICK-DAVIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 SW BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:KS
Mailing Address - Zip Code:67144-9059
Mailing Address - Country:US
Mailing Address - Phone:316-778-1258
Mailing Address - Fax:
Practice Address - Street 1:4914 SW BRIAR LN
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:KS
Practice Address - Zip Code:67144-9059
Practice Address - Country:US
Practice Address - Phone:316-778-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-14
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-45955-061163WP0200X
KS13-62212-061163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult