Provider Demographics
NPI:1831139054
Name:ALEXANDER-LUSK, ALLIE (APRN)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:
Last Name:ALEXANDER-LUSK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HICKMAN
Mailing Address - State:KY
Mailing Address - Zip Code:42050-1841
Mailing Address - Country:US
Mailing Address - Phone:270-236-3337
Mailing Address - Fax:270-236-3340
Practice Address - Street 1:2003 S 7TH ST
Practice Address - Street 2:
Practice Address - City:HICKMAN
Practice Address - State:KY
Practice Address - Zip Code:42050-1841
Practice Address - Country:US
Practice Address - Phone:270-236-3337
Practice Address - Fax:270-236-3340
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3004809OtherKENTUCKY STATE LICENSE