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NPI Code Detail

MEDICARE: ALYSSA TRIPP PA

MEDICARE: ALYSSA TRIPP PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant

General Provider Information

NPI Number : 1710459839
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA TRIPP PA
Provider Business Mailing Address
First Line : 9615 KEILMAN ST
Second Line :
City : SAINT JOHN
State : IN
Zip : 46373-9406
Country : US
Telephone Number : 219-365-0220
Fax Number :
Provider Business Practice Location Address
First Line : 9615 KEILMAN ST
Second Line :
City : SAINT JOHN
State : IN
Zip : 46373-9406
Country : US
Telephone Number : 219-365-0220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/31/2018
Last Update Date : 10/23/2025

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Directions to “ ALYSSA TRIPP PA” Practice Location

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