Basic Information
| Provider Information | |||||||||
| NPI: | 1235513003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORAN | ||||||||
| FirstName: | ALISHIA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | PHYSICIAN ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9225 INDIAN BLUFF RD | ||||||||
| Address2: | |||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324662049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8503033458 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1108 ROSS CLARK CIR | ||||||||
| Address2: | |||||||||
| City: | DOTHAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363013022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347938111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2015 | ||||||||
| LastUpdateDate: | 08/27/2015 | ||||||||
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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 | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.