Provider Demographics
NPI:1780602250
Name:HAMILTON, ALICIA D (CPNP)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:D
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
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Mailing Address - Street 1:1008 S SPRING AVE # 3300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2520
Mailing Address - Country:US
Mailing Address - Phone:314-977-8884
Mailing Address - Fax:
Practice Address - Street 1:1465 S GRAND BLVD
Practice Address - Street 2:4TH FLOOR CARDINAL GLENNON
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1003
Practice Address - Country:US
Practice Address - Phone:314-457-7567
Practice Address - Fax:314-268-4163
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2000172304363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424024701Medicaid
OTH0007Medicare UPIN