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General NPI Number Information
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NPI Number | 1548007131
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Entity Type | Individual
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Provider Name | ALYSSA MARIE GROSS
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Gender | Female
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Dates
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Enumeration Date | 07/10/2024
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 901 W BEN WHITE BLVD
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City | AUSTIN
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State | TX
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Zip | 78704-6903
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Country | US
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Telephone | 512-447-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 2224 WHEATON TRL
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City | CEDAR PARK
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State | TX
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Zip | 78613-1713
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Country | US
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Telephone |
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | PA18769
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License Number State | TX
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