Provider Demographics
NPI:1992041453
Name:WATERS, ALICIA JEAN (MSN, BSN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:JEAN
Last Name:WATERS
Suffix:
Gender:F
Credentials:MSN, BSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 GRASMERE DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-1834
Mailing Address - Country:US
Mailing Address - Phone:412-608-2428
Mailing Address - Fax:
Practice Address - Street 1:6455 MACHINE ST FL 3
Practice Address - Street 2:
Practice Address - City:ABERDEEN PROVING GROUND
Practice Address - State:MD
Practice Address - Zip Code:21005-5213
Practice Address - Country:US
Practice Address - Phone:410-278-1195
Practice Address - Fax:419-278-1766
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP10737363LP0808X
PASP010737363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health