Healthcare Provider Details

I. General information

NPI: 1942671920
Provider Name (Legal Business Name): ALYSSE BRYSON MSPAS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE STE 203
TACOMA WA
98405-5300
US

IV. Provider business mailing address

1780 NW MYHRE RD STE 1220
SILVERDALE WA
98383-8676
US

V. Phone/Fax

Practice location:
  • Phone: 253-382-8150
  • Fax: 253-382-8155
Mailing address:
  • Phone: 360-698-4500
  • Fax: 253-382-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA70097671
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.004492
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA70097671
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: