Provider Demographics
NPI:1780022806
Name:POLSTON, ALISON LEONE (FNP-C)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:LEONE
Last Name:POLSTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 ROGERS RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4614
Mailing Address - Country:US
Mailing Address - Phone:210-541-0700
Mailing Address - Fax:210-541-6868
Practice Address - Street 1:1919 ROGERS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4614
Practice Address - Country:US
Practice Address - Phone:210-541-0700
Practice Address - Fax:210-541-6868
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124334363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX843062OtherNURSE PRACTITIONER LICENSE