Provider Demographics
NPI:1548044597
Name:MCALLISTER, TIA JESSICA ROSE
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:JESSICA ROSE
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 KIEFFER RD
Mailing Address - Street 2:
Mailing Address - City:CRAWLEY
Mailing Address - State:WV
Mailing Address - Zip Code:24931-7076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:207 KIEFFER RD
Practice Address - Street 2:
Practice Address - City:CRAWLEY
Practice Address - State:WV
Practice Address - Zip Code:24931-7076
Practice Address - Country:US
Practice Address - Phone:304-992-6945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant