Provider Demographics
NPI:1912740796
Name:PACHECO, ALISSA MERCEDES (PA-C)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:MERCEDES
Last Name:PACHECO
Suffix:
Gender:
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 1:30 TENTH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-4814
Mailing Address - Country:US
Mailing Address - Phone:774-225-4793
Mailing Address - Fax:
Practice Address - Street 1:1272 W MAIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-6405
Practice Address - Country:US
Practice Address - Phone:401-847-2290
Practice Address - Fax:401-849-8446
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA01720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant