Provider Demographics
NPI:1043992548
Name:GOTTSCHALK, ALYSSA (PA)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:
Last Name:GOTTSCHALK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5107 N CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3989
Mailing Address - Country:US
Mailing Address - Phone:252-255-5321
Mailing Address - Fax:
Practice Address - Street 1:5107 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3989
Practice Address - Country:US
Practice Address - Phone:252-255-5321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant