Provider Demographics
NPI:1720610355
Name:FAUST, ALYSSA ANN (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANN
Last Name:FAUST
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 ROCKY FORD RD
Mailing Address - Street 2:
Mailing Address - City:AVISTON
Mailing Address - State:IL
Mailing Address - Zip Code:62216-1112
Mailing Address - Country:US
Mailing Address - Phone:618-660-7726
Mailing Address - Fax:
Practice Address - Street 1:300 WINDING WOODS DR STE 120
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4772
Practice Address - Country:US
Practice Address - Phone:636-978-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020004281208000000X
MO202016292363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics