Provider Demographics
NPI:1043299373
Name:DIGGS-GOODING, ALISA (PA)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:DIGGS-GOODING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 E RAY RD UNIT 1057
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-4550
Mailing Address - Country:US
Mailing Address - Phone:602-620-6659
Mailing Address - Fax:
Practice Address - Street 1:3324 E RAY RD UNIT 1057
Practice Address - Street 2:
Practice Address - City:HIGLEY
Practice Address - State:AZ
Practice Address - Zip Code:85236-4550
Practice Address - Country:US
Practice Address - Phone:602-620-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744P3200X, 171400000X, 174H00000X, 332B00000X
AZ1864363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ315665Medicaid
AZS47710Medicare UPIN
AZ315665Medicaid