Basic Information
| Provider Information | |||||||||
| NPI: | 1154485977 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALSTON | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | JOEL HEALTH CLINIC BLDG 4851 | ||||||||
| Address2: | |||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109079159 | ||||||||
| FaxNumber: | 9109071038 | ||||||||
| Practice Location | |||||||||
| Address1: | JOEL HEALTH CLINIC BLDG 4851 | ||||||||
| Address2: | |||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109075635 | ||||||||
| FaxNumber: | 9109071038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 07/15/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 1073873 | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 208VP0000X | 0010-02314 | NC | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.