Provider Demographics
NPI:1760821409
Name:MCARDELL, ALYSSA LEIGH (PNP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LEIGH
Last Name:MCARDELL
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:LEIGH
Other - Last Name:STUDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PNP
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-722-2000
Mailing Address - Fax:
Practice Address - Street 1:380 BUTTERFLY GARDENS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7508
Practice Address - Country:US
Practice Address - Phone:614-722-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-16
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14580-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA.14580-NPOtherCERTIFICATE OF AUTHORITY
OH0087541Medicaid
RX.14580-EX1OtherPRESCRIPTIVE AUTHORITY - EXTERNSHIP
OHRN.379936OtherRN LICENSE