Provider Demographics
NPI:1952659906
Name:ANDERSON, ALYSSA BETH (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:BETH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E TABOR CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-1081
Mailing Address - Country:US
Mailing Address - Phone:605-321-9785
Mailing Address - Fax:605-322-8631
Practice Address - Street 1:1000 E 23RD ST STE 230
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2122
Practice Address - Country:US
Practice Address - Phone:605-322-6900
Practice Address - Fax:605-322-6901
Is Sole Proprietor?:No
Enumeration Date:2012-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6838340Medicaid
SDS106475Medicare PIN