Healthcare Provider Details

I. General information

NPI: 1255947404
Provider Name (Legal Business Name): ALYSSA MARIE BIXBY DNP, APRN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E FLOWER ST
PHOENIX AZ
85014-5698
US

IV. Provider business mailing address

1510 E FLOWER ST
PHOENIX AZ
85014-5698
US

V. Phone/Fax

Practice location:
  • Phone: 602-954-0444
  • Fax:
Mailing address:
  • Phone: 602-954-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number247936
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: