Provider Demographics
NPI:1548855521
Name:MCGHEE, CARLISSA (FNP-BC)
Entity type:Individual
Prefix:
First Name:CARLISSA
Middle Name:
Last Name:MCGHEE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CARLISSA
Other - Middle Name:
Other - Last Name:MCGHEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:440 SAINT LUKES DR STE B
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7104
Mailing Address - Country:US
Mailing Address - Phone:334-465-0234
Mailing Address - Fax:
Practice Address - Street 1:440 SAINT LUKES DR STE B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7104
Practice Address - Country:US
Practice Address - Phone:334-593-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-153470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily