Provider Demographics
NPI:1851699060
Name:COOLEY, ALISHA J (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:J
Last Name:COOLEY
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 1:56 TOWER CIR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3476
Mailing Address - Country:US
Mailing Address - Phone:606-677-2913
Mailing Address - Fax:606-677-6983
Practice Address - Street 1:56 TOWER CIR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3476
Practice Address - Country:US
Practice Address - Phone:606-677-2913
Practice Address - Fax:606-677-6983
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006855363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100159420Medicaid
KY707881OtherANTHEM
KYK030200Medicare PIN
KY7100159420Medicaid