Provider Demographics
NPI:1992886840
Name:CROSS, ALISA A (MD)
Entity type:Individual
Prefix:DR
First Name:ALISA
Middle Name:A
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3816 CLEAR CREEK RD STE B
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4401
Mailing Address - Country:US
Mailing Address - Phone:254-220-4474
Mailing Address - Fax:254-220-4476
Practice Address - Street 1:3816 S CLEAR CREEK RD
Practice Address - Street 2:SUTE B
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4400
Practice Address - Country:US
Practice Address - Phone:254-220-4474
Practice Address - Fax:254-300-9939
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA550022084P0800X
TXP21092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A550021Medicaid
W15933Medicare ID - Type Unspecified