Provider Demographics
NPI:1518657436
Name:BURCH, ALISON (PA)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 N MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2735
Mailing Address - Country:US
Mailing Address - Phone:307-234-6988
Mailing Address - Fax:307-472-2854
Practice Address - Street 1:150 N MELROSE ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2735
Practice Address - Country:US
Practice Address - Phone:307-234-6988
Practice Address - Fax:307-472-2854
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPA1323363A00000X
CO390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program