Provider Demographics
NPI:1003560871
Name:HOMEWOOD, ALYSSA JADE (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JADE
Last Name:HOMEWOOD
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 1:450 LAUREL ST STE A
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3045
Mailing Address - Country:US
Mailing Address - Phone:515-207-3608
Mailing Address - Fax:
Practice Address - Street 1:450 LAUREL ST STE A
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3045
Practice Address - Country:US
Practice Address - Phone:515-247-8400
Practice Address - Fax:515-248-8888
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA112210363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant