Healthcare Provider Details

I. General information

NPI: 1679497515
Provider Name (Legal Business Name): ALYSSA WEBB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 W CENTER ST
SHERIDAN AR
72150-8426
US

IV. Provider business mailing address

2314 WAGON TRCE
WHITE HALL AR
71602-8996
US

V. Phone/Fax

Practice location:
  • Phone: 501-313-0592
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: