Provider Demographics
NPI:1669152807
Name:TIMON, ALISHA (RN)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:TIMON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8817 BEAU CHENE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2773
Mailing Address - Country:US
Mailing Address - Phone:318-422-1346
Mailing Address - Fax:
Practice Address - Street 1:611 ABSINTHE CT STE A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-3895
Practice Address - Country:US
Practice Address - Phone:318-422-1346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN108769163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse