Healthcare Provider Details

I. General information

NPI: 1639073604
Provider Name (Legal Business Name): ALYSSA TJADEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 GRAND AVE STE 127
BILLINGS MT
59102-2776
US

IV. Provider business mailing address

2054 VISTA PKWY STE 400
WEST PALM BEACH FL
33411-6742
US

V. Phone/Fax

Practice location:
  • Phone: 561-231-0233
  • Fax: 561-203-3447
Mailing address:
  • Phone: 561-231-0233
  • Fax: 561-203-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-293992
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: