Healthcare Provider Details

I. General information

NPI: 1619800752
Provider Name (Legal Business Name): ALYSSA WILMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA CARROLL

II. Dates (important events)

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

III. Provider practice location address

1017 PIKE ST
MARIETTA OH
45750-3522
US

IV. Provider business mailing address

1017 PIKE ST
MARIETTA OH
45750-3522
US

V. Phone/Fax

Practice location:
  • Phone: 740-371-7007
  • Fax: 740-371-7007
Mailing address:
  • Phone: 740-371-7007
  • Fax: 740-371-7007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.007818
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: