Provider Demographics
NPI:1114793114
Name:EASOM, ALLISON FAYE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:FAYE
Last Name:EASOM
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:GA
Mailing Address - Zip Code:31321-6758
Mailing Address - Country:US
Mailing Address - Phone:229-380-1713
Mailing Address - Fax:
Practice Address - Street 1:8 PALMETTO DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:GA
Practice Address - Zip Code:31321-6758
Practice Address - Country:US
Practice Address - Phone:229-380-1713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN278264363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care