Provider Demographics
NPI:1649937244
Name:BEACH, ALYSSA MORGAN (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MORGAN
Last Name:BEACH
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 1:6611 CLYO RD STE F
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2785
Mailing Address - Country:US
Mailing Address - Phone:937-208-5300
Mailing Address - Fax:
Practice Address - Street 1:110 N MAIN ST STE 350
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-3735
Practice Address - Country:US
Practice Address - Phone:866-608-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006909363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant