Provider Demographics
NPI:1497023220
Name:AUTREY, ALICE JEAN
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:JEAN
Last Name:AUTREY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ALICE
Other - Middle Name:BAINES
Other - Last Name:AUTREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:702 N RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-3008
Mailing Address - Country:US
Mailing Address - Phone:281-780-1530
Mailing Address - Fax:
Practice Address - Street 1:702 N RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-3008
Practice Address - Country:US
Practice Address - Phone:281-780-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide