Provider Demographics
NPI:1679353692
Name:COURSEY, ALICIA ROBIN (CCHT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ROBIN
Last Name:COURSEY
Suffix:
Gender:F
Credentials:CCHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2087 E 430TH RD
Mailing Address - Street 2:
Mailing Address - City:HALF WAY
Mailing Address - State:MO
Mailing Address - Zip Code:65663-9131
Mailing Address - Country:US
Mailing Address - Phone:417-399-9210
Mailing Address - Fax:
Practice Address - Street 1:2101 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1888
Practice Address - Country:US
Practice Address - Phone:417-326-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal Dialysis