Provider Demographics
NPI:1417918384
Name:WREN, ALISHA APRIELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISHA
Middle Name:APRIELLE
Last Name:WREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 MONARCH TERRACE DR APT 2707
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0669
Mailing Address - Country:US
Mailing Address - Phone:510-798-0153
Mailing Address - Fax:713-893-6717
Practice Address - Street 1:2506 MONARCH TERRACE DR APT 2707
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0669
Practice Address - Country:US
Practice Address - Phone:510-798-0153
Practice Address - Fax:713-893-6717
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9749207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213105401Medicaid
TX8CH899OtherBCBS TX
TX1417918384OtherTRI CARE SOUTH
TX1417918384OtherBCBS TX
TXTXB105044Medicare PIN
TX1417918384OtherBCBS TX
TX213105401Medicaid