Provider Demographics
NPI:1568977635
Name:PAULL, ALYSE KATHLEEN (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALYSE
Middle Name:KATHLEEN
Last Name:PAULL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ESTIMA CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-4567
Mailing Address - Country:US
Mailing Address - Phone:512-636-2181
Mailing Address - Fax:
Practice Address - Street 1:709 S. BAGDAD RD
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641
Practice Address - Country:US
Practice Address - Phone:512-260-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily