Provider Demographics
NPI:1962607556
Name:SIMPSON, ALYSSA (RDN, CGN, CLT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:RDN, CGN, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 N CENTRAL AVE # 831
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2185
Mailing Address - Country:US
Mailing Address - Phone:602-422-9800
Mailing Address - Fax:602-804-0422
Practice Address - Street 1:349 E CORONADO RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1525
Practice Address - Country:US
Practice Address - Phone:602-422-9800
Practice Address - Fax:602-264-9101
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ930584133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27-1732306OtherTAX ID