Provider Demographics
NPI:1366037749
Name:MCCOOL, ALISHA NICOLE GRAY (MNSC, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:NICOLE GRAY
Last Name:MCCOOL
Suffix:
Gender:F
Credentials:MNSC, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 JFK BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6756
Mailing Address - Country:US
Mailing Address - Phone:501-291-1126
Mailing Address - Fax:
Practice Address - Street 1:287 S BROADVIEW ST STE B-3
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9233
Practice Address - Country:US
Practice Address - Phone:501-209-3362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-07
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR214946363LP0808X
ARAR214946363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1972376309OtherNPI