Provider Demographics
NPI:1184227605
Name:ALLISON, NITA KAY (DPH)
Entity Type:Individual
Prefix:DR
First Name:NITA
Middle Name:KAY
Last Name:ALLISON
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:798 W SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-1727
Mailing Address - Country:US
Mailing Address - Phone:870-735-2324
Mailing Address - Fax:870-732-2926
Practice Address - Street 1:798 W SERVICE RD
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1727
Practice Address - Country:US
Practice Address - Phone:870-735-2324
Practice Address - Fax:870-732-2926
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist