Provider Demographics
NPI:1841829579
Name:MATTHEWS, ALISHA SHANELL
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:SHANELL
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:SHANELL
Other - Last Name:CALENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:145 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-3366
Mailing Address - Country:US
Mailing Address - Phone:601-503-7514
Mailing Address - Fax:
Practice Address - Street 1:3794 HIGHWAY 468 W
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-9008
Practice Address - Country:US
Practice Address - Phone:601-932-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-04
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903503363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily