Provider Demographics
NPI:1093075269
Name:ANDERSON, ALICIA WILLIAMS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:WILLIAMS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 51913
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-0032
Mailing Address - Country:US
Mailing Address - Phone:843-945-3030
Mailing Address - Fax:843-650-4019
Practice Address - Street 1:185 FRESH DR STE A
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4436
Practice Address - Country:US
Practice Address - Phone:843-945-3030
Practice Address - Fax:843-650-4019
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily