Provider Demographics
NPI:1356949150
Name:ALSTON, OPAL MARCIA (FNP)
Entity type:Individual
Prefix:
First Name:OPAL
Middle Name:MARCIA
Last Name:ALSTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:OPAL
Other - Middle Name:MARCIA
Other - Last Name:ALSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2211 CHIPPEWA DR
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2211 CHIPPEWA DR
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-2090
Practice Address - Country:US
Practice Address - Phone:718-753-9520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1014889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily