Healthcare Provider Details

I. General information

NPI: 1972467751
Provider Name (Legal Business Name): ALISON WESSEL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 VILLAGE CENTER BLVD
MYRTLE BEACH SC
29579-6706
US

IV. Provider business mailing address

400 GOODYS LN
KNOXVILLE TN
37922-1914
US

V. Phone/Fax

Practice location:
  • Phone: 843-353-3460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: