Provider Demographics
NPI:1114559283
Name:GLENN, ALICIA WILSON (DNP, AGPCNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:WILSON
Last Name:GLENN
Suffix:
Gender:F
Credentials:DNP, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 JOHN KNOX DR
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27235-9662
Mailing Address - Country:US
Mailing Address - Phone:336-668-4900
Mailing Address - Fax:
Practice Address - Street 1:1575 JOHN KNOX DR
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:NC
Practice Address - Zip Code:27235-9662
Practice Address - Country:US
Practice Address - Phone:336-668-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013383363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care