Healthcare Provider Details

I. General information

NPI: 1235981408
Provider Name (Legal Business Name): ALYSON WHITE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11397 MONTGOMERY RD
CINCINNATI OH
45249-2332
US

IV. Provider business mailing address

111 E MARKHAM ST APT B509
LITTLE ROCK AR
72201-1571
US

V. Phone/Fax

Practice location:
  • Phone: 870-299-1520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: