Provider Demographics
NPI:1447749015
Name:WHITTINGTON, ALISA G (FNP)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:G
Last Name:WHITTINGTON
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 BELLE ISLE AVE STE 110J
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8336
Mailing Address - Country:US
Mailing Address - Phone:844-994-6633
Mailing Address - Fax:470-300-7913
Practice Address - Street 1:1671 BELLE ISLE AVE STE 110J
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8336
Practice Address - Country:US
Practice Address - Phone:844-994-6633
Practice Address - Fax:470-300-7913
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP5233Medicaid