Provider Demographics
NPI:1255972154
Name:PRESTON, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:PRESTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRAVELING
Other - Middle Name:
Other - Last Name:GRACE LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1636 POPPS FERRY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2276
Mailing Address - Country:US
Mailing Address - Phone:833-244-7223
Mailing Address - Fax:833-962-6222
Practice Address - Street 1:1636 N POPPS FERRY RD STE 110
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2276
Practice Address - Country:US
Practice Address - Phone:833-244-7223
Practice Address - Fax:833-962-6222
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)