Provider Demographics
NPI:1699492421
Name:SACKETT, ALYSSA JANE (FNP-C)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JANE
Last Name:SACKETT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 LUCAS AVE
Mailing Address - Street 2:
Mailing Address - City:PIERSON
Mailing Address - State:IA
Mailing Address - Zip Code:51048-8071
Mailing Address - Country:US
Mailing Address - Phone:515-450-8335
Mailing Address - Fax:
Practice Address - Street 1:1111 11TH ST
Practice Address - Street 2:
Practice Address - City:HAWARDEN
Practice Address - State:IA
Practice Address - Zip Code:51023-1903
Practice Address - Country:US
Practice Address - Phone:712-551-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA171569363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA171569OtherIOWA ADVANCED REGISTERED NURSE PRACTITIONER LICENSE
IAF08220001OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD