Provider Demographics
NPI:1992223887
Name:DAMIENS, ALISSA NICHOLAS (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:NICHOLAS
Last Name:DAMIENS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 MYRLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-9530
Mailing Address - Country:US
Mailing Address - Phone:662-571-2911
Mailing Address - Fax:
Practice Address - Street 1:230 WYETH LN
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-4653
Practice Address - Country:US
Practice Address - Phone:662-746-8962
Practice Address - Fax:662-746-8964
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902276363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily