Provider Demographics
NPI:1558074971
Name:GOODALE, ALYSON (PA)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:GOODALE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 505673
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5673
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:1000 E PRIMROSE ST STE 170
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5192
Practice Address - Country:US
Practice Address - Phone:417-269-6000
Practice Address - Fax:417-269-9853
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2024-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2024003085363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant