Healthcare Provider Details

I. General information

NPI: 1699345223
Provider Name (Legal Business Name): MS. ALYSSA ERIN WHITED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ALYSSA ERIN HUBBARD

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 MARKET ST
NORTH TAZEWELL VA
24630-5016
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 276-988-8850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110008351
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: