Provider Demographics
NPI:1639543721
Name:KOLLE, ALISHA J (CPNP-AC)
Entity Type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:J
Last Name:KOLLE
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28765 AL HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:AL
Mailing Address - Zip Code:35739-8709
Mailing Address - Country:US
Mailing Address - Phone:256-777-6310
Mailing Address - Fax:
Practice Address - Street 1:502 GOVERNORS DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5126
Practice Address - Country:US
Practice Address - Phone:256-533-0833
Practice Address - Fax:256-533-0833
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20732363LP0222X
AL1-132523363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care