Healthcare Provider Details

I. General information

NPI: 1467324665
Provider Name (Legal Business Name): ALYSSA HAMILTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 SOUTHPOINTE DR STE D2
INDIANAPOLIS IN
46227-7505
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-1006
  • Fax:
Mailing address:
  • Phone: 317-621-7547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10005017A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: