Provider Demographics
NPI:1245564186
Name:SPELLMANN, ALISA (APN)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:SPELLMANN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 SPRINGHILL DR
Mailing Address - Street 2:STE 100
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2905
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-686-5884
Practice Address - Street 1:4301 W MARKHAM ST # 783
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-8000
Practice Address - Fax:501-686-5884
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA03267363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR179137758Medicaid
AR5V281Medicare PIN