Provider Demographics
NPI:1275296477
Name:HUSTON, ALYSSA BROOKE
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BROOKE
Last Name:HUSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:BROOKE
Other - Last Name:GREATHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1465 SKYWAY DR
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-4459
Mailing Address - Country:US
Mailing Address - Phone:812-374-2121
Mailing Address - Fax:
Practice Address - Street 1:1701 THOMSON DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1118
Practice Address - Country:US
Practice Address - Phone:434-200-4522
Practice Address - Fax:434-200-6086
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2022-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily