Provider Demographics
NPI:1083990337
Name:ROCKHOLD, ALYSON PATRICE (PA-C, MPH)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:PATRICE
Last Name:ROCKHOLD
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:
Other - Last Name:VANTIEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPH
Mailing Address - Street 1:1500 UNIVERSITY DR E STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-383-2340
Mailing Address - Fax:979-731-4570
Practice Address - Street 1:1103 WOODSON DR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-1052
Practice Address - Country:US
Practice Address - Phone:979-567-7080
Practice Address - Fax:979-567-9783
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX881N92OtherBCBS TX
TX881N92OtherBCBS TX