Provider Demographics
NPI:1538121538
Name:FINEGAN, ALICE (NP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:FINEGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:STOCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:78160-0098
Mailing Address - Country:US
Mailing Address - Phone:830-996-3701
Mailing Address - Fax:830-996-3749
Practice Address - Street 1:601 PERSON ST
Practice Address - Street 2:
Practice Address - City:STOCKDALE
Practice Address - State:TX
Practice Address - Zip Code:78160
Practice Address - Country:US
Practice Address - Phone:830-996-3701
Practice Address - Fax:830-996-3749
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX544298363L00000X
TXAP114263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1766453-02Medicaid
TXP00269388OtherRR/MEDICARE
TX8N9782OtherBLUE SHIELD
TXQ54628Medicare UPIN
TX8G1836Medicare ID - Type Unspecified