Provider Demographics
NPI:1912214958
Name:SNOW, ALYSSA BRIANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BRIANNE
Last Name:SNOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:BRIANNE
Other - Last Name:VANDER HEYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2012 S PROMENADE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9073
Mailing Address - Country:US
Mailing Address - Phone:479-616-1485
Mailing Address - Fax:479-239-0536
Practice Address - Street 1:2012 S PROMENADE BLVD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9073
Practice Address - Country:US
Practice Address - Phone:479-616-1485
Practice Address - Fax:479-239-0536
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1689363A00000X
IN10001210363A00000X
PAMA07081363AS0400X
ARPA-734363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical