Provider Demographics
NPI:1407311863
Name:HERNANDEZ, ALYSSA ARIELLE (PA-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ARIELLE
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N VALLEY MILLS DR STE 408F
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7000
Mailing Address - Country:US
Mailing Address - Phone:254-523-3622
Mailing Address - Fax:254-523-3623
Practice Address - Street 1:408 N VALLEY MILLS DR STE 408F
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7000
Practice Address - Country:US
Practice Address - Phone:254-523-3622
Practice Address - Fax:254-523-3623
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56061363AM0700X
TXPA18467363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical