Provider Demographics
NPI:1538589072
Name:SCOTT, ALISHA (PA-C)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:
Other - Last Name:LECHEMINANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:ID
Mailing Address - Zip Code:83421-0306
Mailing Address - Country:US
Mailing Address - Phone:801-572-3750
Mailing Address - Fax:801-572-1097
Practice Address - Street 1:2065 E 17TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8042
Practice Address - Country:US
Practice Address - Phone:800-640-3451
Practice Address - Fax:385-287-1900
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-2219363A00000X
WAPA60424823363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA332584OtherSTATE L&I
WAG8931132Medicare PIN
WAG8931133Medicare PIN