Provider Demographics
NPI:1902450307
Name:EVITTS, ALISHA B (HIS)
Entity Type:Individual
Prefix:MS
First Name:ALISHA
Middle Name:B
Last Name:EVITTS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W EVERLY BROS BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-2708
Mailing Address - Country:US
Mailing Address - Phone:270-754-5133
Mailing Address - Fax:270-754-5133
Practice Address - Street 1:614 E ARCH ST STE A
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2178
Practice Address - Country:US
Practice Address - Phone:270-824-8288
Practice Address - Fax:270-824-3932
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251353237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist