Healthcare Provider Details

I. General information

NPI: 1366894578
Provider Name (Legal Business Name): ALYSSA MAE PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2196 VETERANS PKWY
CLAYTON NC
27520-8343
US

IV. Provider business mailing address

PO BOX 5105
BELFAST ME
04915-5100
US

V. Phone/Fax

Practice location:
  • Phone: 919-763-1050
  • Fax: 919-969-9131
Mailing address:
  • Phone: 919-763-1050
  • Fax: 919-969-9131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16888
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT004978
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: