Provider Demographics
NPI:1811223001
Name:SU, ALICIA KAREN (RN MSN)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:KAREN
Last Name:SU
Suffix:
Gender:F
Credentials:RN MSN
Other - Prefix:MRS
Other - First Name:ALICIA
Other - Middle Name:KAREN
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 W COLLEGE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3580
Mailing Address - Country:US
Mailing Address - Phone:817-424-5959
Mailing Address - Fax:817-416-7441
Practice Address - Street 1:4375 BOOTH CALLOWAY RD STE 505
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8359
Practice Address - Country:US
Practice Address - Phone:972-566-4822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX609770363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care