Healthcare Provider Details

I. General information

NPI: 1184557787
Provider Name (Legal Business Name): ALYSSA PAIGE HEINLEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 DIAMOND PKWY
NORTH KANSAS CITY MO
64116-4328
US

IV. Provider business mailing address

9700 W 118TH TER APT 7
OVERLAND PARK KS
66210-3154
US

V. Phone/Fax

Practice location:
  • Phone: 816-561-3003
  • Fax:
Mailing address:
  • Phone: 614-569-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2026034521
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: