Healthcare Provider Details

I. General information

NPI: 1144965666
Provider Name (Legal Business Name): ALYSSA JO PRATT DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA JO PRATT

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 METROMEDICAL DR
FAYETTEVILLE NC
28304-3861
US

IV. Provider business mailing address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-4191
  • Fax:
Mailing address:
  • Phone: 910-484-4191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number855
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number855
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number855
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: