Provider Demographics
NPI:1093294969
Name:HEATH, ALICIA (LVN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:HEATH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 QUINN AVE
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-4409
Mailing Address - Country:US
Mailing Address - Phone:715-797-3080
Mailing Address - Fax:
Practice Address - Street 1:3316 QUINN AVE
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-4409
Practice Address - Country:US
Practice Address - Phone:715-797-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health