Healthcare Provider Details

I. General information

NPI: 1710619085
Provider Name (Legal Business Name): ALYSSA EDEN GRAFF PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA EDEN WATSON PA

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5212 W VILLAGE PKWY STE 8
ROGERS AR
72758-8190
US

IV. Provider business mailing address

4357 W WEDGE DR
FAYETTEVILLE AR
72704-7517
US

V. Phone/Fax

Practice location:
  • Phone: 479-324-2671
  • Fax:
Mailing address:
  • Phone: 918-833-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1356
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: