Provider Demographics
NPI:1699251157
Name:HEATHMAN, ALYSSA BROOKE (PA)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:BROOKE
Last Name:HEATHMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:BROOKE
Other - Last Name:ERHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-5455
Mailing Address - Fax:515-643-6459
Practice Address - Street 1:1601 NW 114TH ST STE 151
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7046
Practice Address - Country:US
Practice Address - Phone:515-643-5455
Practice Address - Fax:515-643-6459
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092820363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA092820OtherBUREAU OF PROFESSIONAL LICENSURE