Provider Demographics
NPI:1720342850
Name:KING, ALYSON FRANCES (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:FRANCES
Last Name:KING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ALYSON
Other - Middle Name:KING
Other - Last Name:GANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:76 BATTERSON PARK RD STE 106
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2571
Mailing Address - Country:US
Mailing Address - Phone:860-249-8266
Mailing Address - Fax:203-816-5564
Practice Address - Street 1:76 BATTERSON PARK RD STE 106
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2571
Practice Address - Country:US
Practice Address - Phone:860-249-8266
Practice Address - Fax:203-816-5564
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002759363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical