Provider Demographics
NPI:1932201381
Name:MADDOX, ALISON CHRISTINE (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:CHRISTINE
Last Name:MADDOX
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5477 MOORETOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2108
Mailing Address - Country:US
Mailing Address - Phone:757-561-5677
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:5477 MOORETOWN RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2108
Practice Address - Country:US
Practice Address - Phone:757-561-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001240680163W00000X
NE60729163W00000X
VA0024169397363LP0808X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024169397OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONS