Provider Demographics
NPI:1699345223
Name:WHITED, ALYSSA ERIN
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:ERIN
Last Name:WHITED
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ALYSSA
Other - Middle Name:ERIN
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1303 RUGBY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-3717
Practice Address - Country:US
Practice Address - Phone:276-970-1147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-27
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant