Provider Demographics
NPI:1053626648
Name:EARLEY, ALICIA M (FNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:EARLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3202
Mailing Address - Fax:
Practice Address - Street 1:30845 N CAVE CREEK RD STE 101
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-2916
Practice Address - Country:US
Practice Address - Phone:480-488-9220
Practice Address - Fax:480-488-7014
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10424363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03301517Medicaid
NY03301517Medicaid