Provider Demographics
NPI:1437504040
Name:HANSON, ALLYSON A (MD)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:A
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 MEADOW RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-8998
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 E 20TH ST STE D
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-8222
Practice Address - Country:US
Practice Address - Phone:870-729-1911
Practice Address - Fax:870-729-1789
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4313207Q00000X
ARE-11171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1F4924OtherMEDICARE
AR1H7120OtherMEDICARE
AR2R8738OtherMEDICARE
TXP02599433OtherRR MCR