Provider Demographics
NPI:1427486216
Name:WRISTON, ALYSSA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:WRISTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:FRYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1448 10TH AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3579
Mailing Address - Country:US
Mailing Address - Phone:304-691-8722
Mailing Address - Fax:304-691-8591
Practice Address - Street 1:300 CORPORATE CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560
Practice Address - Country:US
Practice Address - Phone:304-691-6800
Practice Address - Fax:304-691-6751
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01748363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical