Provider Demographics
NPI:1447768296
Name:DEAN, ALISSA LEA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:LEA
Last Name:DEAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10730 MIDLAND TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-9679
Mailing Address - Country:US
Mailing Address - Phone:606-393-6193
Mailing Address - Fax:
Practice Address - Street 1:10730 MIDLAND TRAIL RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-9679
Practice Address - Country:US
Practice Address - Phone:606-393-6193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011994363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily