Provider Demographics
NPI:1295596765
Name:WALTON, ALYSSA CERDEIRA
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CERDEIRA
Last Name:WALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 CURRY PIKE APT 1
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-9754
Mailing Address - Country:US
Mailing Address - Phone:859-325-6001
Mailing Address - Fax:
Practice Address - Street 1:200 CURRY PIKE APT 1
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-9754
Practice Address - Country:US
Practice Address - Phone:859-325-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant