Provider Demographics
NPI:1750134417
Name:PRINCE, ALISHA NICOLE
Entity type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:NICOLE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5261 HIGHWAY 145
Mailing Address - Street 2:
Mailing Address - City:MC CRORY
Mailing Address - State:AR
Mailing Address - Zip Code:72101-5000
Mailing Address - Country:US
Mailing Address - Phone:870-731-4123
Mailing Address - Fax:
Practice Address - Street 1:202 N EDMONDS AVE
Practice Address - Street 2:
Practice Address - City:MC CRORY
Practice Address - State:AR
Practice Address - Zip Code:72101-8000
Practice Address - Country:US
Practice Address - Phone:870-731-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator