Provider Demographics
NPI:1992162135
Name:TAYLOR, ALISA
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 SOUTHWEST DR STE A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5809
Mailing Address - Country:US
Mailing Address - Phone:833-847-4376
Mailing Address - Fax:870-459-4077
Practice Address - Street 1:509 SOUTHWEST DR STE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5809
Practice Address - Country:US
Practice Address - Phone:870-206-7700
Practice Address - Fax:870-459-4077
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist