Basic Information
| Provider Information | |||||||||
| NPI: | 1619031846 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLUKER | ||||||||
| FirstName: | ALISHA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PMHNP-BC, WHCNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 RIVER BEND DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752476945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147431200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9708 SKILLMAN ST | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752435150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142215433 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 670559 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LP0808X | 670559 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 180670503 | 05 | TX | MEDICAID | 180670504 | 05 | TX | MEDICAID | 180670506 | 05 | TX | MEDICAID | 180670507 | 05 | TX | MEDICAID | 180670508 | 05 | TX | MEDICAID | 8Y5478 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 180670510 | 05 | TX | MEDICAID | 180670511 | 05 | TX | MEDICAID | 180670509 | 05 | TX | MEDICAID | 180670502 | 05 | TX | MEDICAID | 180670505 | 05 | TX | MEDICAID |