Provider Demographics
NPI:1962709543
Name:PRICE, ALICE DIANE (PA-C)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:DIANE
Last Name:PRICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 TIMBER LAKES DR
Mailing Address - Street 2:
Mailing Address - City:TODD
Mailing Address - State:NC
Mailing Address - Zip Code:28684-9002
Mailing Address - Country:US
Mailing Address - Phone:828-264-1337
Mailing Address - Fax:828-268-9963
Practice Address - Street 1:156 TIMBER LAKES DR
Practice Address - Street 2:
Practice Address - City:TODD
Practice Address - State:NC
Practice Address - Zip Code:28684-9002
Practice Address - Country:US
Practice Address - Phone:828-264-1337
Practice Address - Fax:828-268-9963
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-02656OtherNC MEDICAL BOARD