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General NPI Number Information
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NPI Number | 1407311863
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Entity Type | Individual
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Provider Name | ALYSSA ARIELLE HERNANDEZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/08/2019
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 408 N VALLEY MILLS DR STE 408F
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City | WACO
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State | TX
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Zip | 76710-7000
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Country | US
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Telephone | 254-523-3622
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Fax | 254-523-3623
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Provider Business Mailing Address
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Address Line | 408 N VALLEY MILLS DR STE 408F
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City | WACO
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State | TX
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Zip | 76710-7000
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Country | US
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Telephone | 254-523-3622
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Fax | 254-523-3623
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 56061
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA18467
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License Number State | TX
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