Provider Demographics
NPI:1760032544
Name:PRICE, ALYSSA M (PA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:M
Last Name:PRICE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:M
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2108 E THOMAS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7761
Mailing Address - Country:US
Mailing Address - Phone:602-933-3124
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-3033
Practice Address - Fax:602-933-5245
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPENDING363A00000X
AZ7623363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant