Provider Demographics
NPI:1689308140
Name:EGON, ALYESSA (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ALYESSA
Middle Name:
Last Name:EGON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 125TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-7904
Mailing Address - Country:US
Mailing Address - Phone:806-300-3180
Mailing Address - Fax:
Practice Address - Street 1:2602 AVENUE Q
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79411-2444
Practice Address - Country:US
Practice Address - Phone:806-747-1780
Practice Address - Fax:806-744-4432
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX1100423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program