Provider Demographics
NPI:1982149878
Name:ORTEGA, ALLYSE MARIE (FNP-C, AGACNP, RN)
Entity Type:Individual
Prefix:
First Name:ALLYSE
Middle Name:MARIE
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:FNP-C, AGACNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:3449 PHEASANT MEADOW DR STE 107
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7364
Mailing Address - Country:US
Mailing Address - Phone:636-385-5556
Mailing Address - Fax:636-614-2093
Practice Address - Street 1:3449 PHEASANT MEADOW DR STE 107
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7364
Practice Address - Country:US
Practice Address - Phone:636-385-5556
Practice Address - Fax:636-614-2093
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020396163WE0003X
MO2023000801363LA2100X
MO2017001487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care