Provider Demographics
NPI:1083968648
Name:LANCASTER, ALLYSON MAINS (NP)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:MAINS
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:MAINS
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:212 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-4207
Mailing Address - Country:US
Mailing Address - Phone:478-923-1014
Mailing Address - Fax:478-923-1017
Practice Address - Street 1:212 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-4207
Practice Address - Country:US
Practice Address - Phone:478-923-1014
Practice Address - Fax:478-923-1017
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN224906363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN224906OtherLICENSE