Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 105808 | WV |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 105808 | WV |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 105808 | WV |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN.CNP.0027650 | OH |
NPI | 1174781553 |
---|---|
Provider Name | Mrs. Alisha Janelle Grayson |
First Address | Hungtingon, WV 25704 |
Second Address | Hungtingon, WV 25704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2008 |
Last Update Date | 23/08/2021 |