Provider Demographics
NPI:1114777257
Name:MAYO, ALLYSA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALLYSA
Middle Name:
Last Name:MAYO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ASPEN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:VILONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72173-9051
Mailing Address - Country:US
Mailing Address - Phone:940-390-5116
Mailing Address - Fax:
Practice Address - Street 1:2425 PRINCE ST STE 3
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3701
Practice Address - Country:US
Practice Address - Phone:940-390-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR227944363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily