Healthcare Provider Details

I. General information

NPI: 1790537157
Provider Name (Legal Business Name): ALESSIA R BRYANT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 ROYAL AVE STE 110
MEDFORD OR
97504-6461
US

IV. Provider business mailing address

PO BOX 31001
PASADENA CA
91110-4180
US

V. Phone/Fax

Practice location:
  • Phone: 541-732-8170
  • Fax:
Mailing address:
  • Phone: 541-732-8370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA221813
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: