Provider Demographics
NPI:1205972544
Name:PHILLIPS, ALISHA LORRAINE (FNP)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:LORRAINE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-2535
Mailing Address - Country:US
Mailing Address - Phone:208-642-3396
Mailing Address - Fax:208-642-9060
Practice Address - Street 1:823 CENTER AVE
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2535
Practice Address - Country:US
Practice Address - Phone:208-642-3396
Practice Address - Fax:208-642-9060
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-19189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NPPU5OtherBLUE CROSS
820525763OtherCOMMERCIAL
ID806957500Medicaid
000010147752OtherREGENCE BLUE SHIELD
OR278542Medicaid