Provider Demographics
NPI:1225667447
Name:LARSON, ALYSSA JEWEL (DNP, FNP - C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JEWEL
Last Name:LARSON
Suffix:
Gender:F
Credentials:DNP, FNP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 RIVERFRONT PKWY UNIT 204
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402
Mailing Address - Country:US
Mailing Address - Phone:423-260-0626
Mailing Address - Fax:
Practice Address - Street 1:207 SPEARS AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3840
Practice Address - Country:US
Practice Address - Phone:423-756-7644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily