Provider Demographics
NPI:1992830152
Name:ABBEY, ALYSSA D (PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:D
Last Name:ABBEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 NW SHEVLIN PARK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-7102
Mailing Address - Country:US
Mailing Address - Phone:541-706-3819
Mailing Address - Fax:541-429-6659
Practice Address - Street 1:2195 NW SHEVLIN PARK RD STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7102
Practice Address - Country:US
Practice Address - Phone:541-706-3819
Practice Address - Fax:541-429-6659
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
ORPA01225363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR11933680OtherCAQH
OR500605198Medicaid
OR00834446OtherMEDICARE RAILROAD
OR500605198Medicaid