Provider Demographics
NPI:1558648949
Name:HERRON, ALYSSA C (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:C
Last Name:HERRON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:C
Other - Last Name:CROWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 FARRINGTON CORNER RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:NH
Mailing Address - Zip Code:03229-2020
Mailing Address - Country:US
Mailing Address - Phone:603-228-7575
Mailing Address - Fax:603-228-7585
Practice Address - Street 1:19 FARRINGTON CORNER RD
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:NH
Practice Address - Zip Code:03229-2020
Practice Address - Country:US
Practice Address - Phone:603-228-7575
Practice Address - Fax:603-228-7585
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05126363A00000X
NH0860363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103674Medicaid
NC1558648949Medicaid
NC1558648949Medicaid