Provider Demographics
NPI:1740614312
Name:ALLEN, ALISHA MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:MICHELLE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7632 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-7106
Mailing Address - Country:US
Mailing Address - Phone:385-222-1711
Mailing Address - Fax:
Practice Address - Street 1:7632 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-7106
Practice Address - Country:US
Practice Address - Phone:385-222-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT359746-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant