MEDICARE: ALYSSE BRYSON MSPAS, PA-C

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
1	363AS0400X	Surgical Physician Assistant	PA70097671	WA
2	363AM0700X	Medical Physician Assistant	PA70097671	WA
3	363AM0700X	Medical Physician Assistant	50.004492	OH

General Provider Information

NPI Number	:	1942671920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSE BRYSON MSPAS, PA-C

Provider Business Mailing Address
First Line	:	1780 NW MYHRE RD STE 1220
Second Line	:
City	:	SILVERDALE
State	:	WA
Zip	:	98383-8676
Country	:	US
Telephone Number	:	360-698-4500
Fax Number	:	253-382-8155

Provider Business Practice Location Address
First Line	:	1708 YAKIMA AVE STE 203
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-5300
Country	:	US
Telephone Number	:	253-382-8150
Fax Number	:	253-382-8155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	05/28/2026

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