Provider Demographics
NPI:1952693087
Name:WARD, ALICE FAYE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:FAYE
Last Name:WARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAN STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37708-4257
Mailing Address - Country:US
Mailing Address - Phone:423-993-4135
Mailing Address - Fax:423-993-4135
Practice Address - Street 1:313 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1724
Practice Address - Country:US
Practice Address - Phone:606-654-3338
Practice Address - Fax:606-654-2273
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015748363LF0000X
KY3008865363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100329430Medicaid