Provider Demographics
NPI:1720575467
Name:BRANSCUM, ALISA KAY (APRN)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:KAY
Last Name:BRANSCUM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2708 S RIFE MEDICAL LN STE 220
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1456
Mailing Address - Country:US
Mailing Address - Phone:479-338-4400
Mailing Address - Fax:
Practice Address - Street 1:2708 S RIFE MEDICAL LN STE 220
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758
Practice Address - Country:US
Practice Address - Phone:479-338-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR069486163W00000X
ARA005798363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse