Healthcare Provider Details

I. General information

NPI: 1710459839
Provider Name (Legal Business Name): ALYSSA KAY TRIPP PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2018
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

9615 KEILMAN ST
SAINT JOHN IN
46373-9406
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-5577
  • Fax: 415-502-2236
Mailing address:
  • Phone: 219-365-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA68829
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: