1922575034 NPI number — MRS. ALYSSA MICHELLE HOUCK PA-C

Table of content: MRS. ALYSSA MICHELLE HOUCK PA-C (NPI 1922575034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922575034 NPI number — MRS. ALYSSA MICHELLE HOUCK PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUCK
Provider First Name:
ALYSSA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'BRIEN
Provider Other First Name:
ALYSSA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922575034
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5601 ARRINGDON PARK DR STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27560-5677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-572-4678
Provider Business Mailing Address Fax Number:
919-484-0461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5601 ARRINGDON PARK DR STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27560-5677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-572-4678
Provider Business Practice Location Address Fax Number:
919-484-0461
Provider Enumeration Date:
10/26/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  C0006992 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 0110-006681 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 0010-11228 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)