Healthcare Provider Details

I. General information

NPI: 1629997572
Provider Name (Legal Business Name): ALYSSA ASHLEY MCNAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29975 HARBOR WAY STE A
GOLD BEACH OR
97444-9300
US

IV. Provider business mailing address

PO BOX 8
WEDDERBURN OR
97491-0008
US

V. Phone/Fax

Practice location:
  • Phone: 541-261-6857
  • Fax:
Mailing address:
  • Phone: 541-261-6857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10063884
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: