Provider Demographics
NPI:1558960674
Name:WALLS, ALICIA N (APRN, FNP-C, PMHNP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:N
Last Name:WALLS
Suffix:
Gender:F
Credentials:APRN, FNP-C, PMHNP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:WALLS-HOLLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 WAGNER RD
Mailing Address - Street 2:
Mailing Address - City:WEST MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45383-1612
Mailing Address - Country:US
Mailing Address - Phone:937-760-8960
Mailing Address - Fax:937-500-5401
Practice Address - Street 1:110 S STANFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3689
Practice Address - Country:US
Practice Address - Phone:937-787-6859
Practice Address - Fax:937-500-5401
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027836363L00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0442294Medicaid