Healthcare Provider Details

I. General information

NPI: 1265242523
Provider Name (Legal Business Name): ALYSSA JUDD MAYO PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WINDSOR PATH STE 5
GEORGETOWN KY
40324-9819
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 866-636-2674
  • Fax:
Mailing address:
  • Phone:
  • Fax: 513-672-9985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4029930
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: