Provider Demographics
NPI:1265242523
Name:MAYO, ALYSSA JUDD (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JUDD
Last Name:MAYO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-1762
Mailing Address - Country:US
Mailing Address - Phone:859-473-1499
Mailing Address - Fax:
Practice Address - Street 1:1210 KY HIGHWAY 36 E UNIT 1
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7498
Practice Address - Country:US
Practice Address - Phone:859-473-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4029930363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty