Provider Demographics
NPI:1861732919
Name:MCCONNELL, ALISHA LA'TRICE
Entity type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:LA'TRICE
Last Name:MCCONNELL
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 1:1128 N BRADEN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-6417
Mailing Address - Country:US
Mailing Address - Phone:918-951-2867
Mailing Address - Fax:
Practice Address - Street 1:1128 N BRADEN AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-6417
Practice Address - Country:US
Practice Address - Phone:918-951-2867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist