Provider Demographics
NPI:1912798471
Name:NABOURS, ALISHA (PA-C)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:NABOURS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2637 TUMWATER LN
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2494
Mailing Address - Country:US
Mailing Address - Phone:918-774-3133
Mailing Address - Fax:
Practice Address - Street 1:2637 TUMWATER LN
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2494
Practice Address - Country:US
Practice Address - Phone:918-774-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66368363A00000X
NMPA2025-0044363A00000X
COPA.0009122363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant