Provider Demographics
NPI:1487712469
Name:CARPENTER, ALYSSA A
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:A
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9727 ROCKY FORK RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43071-9781
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5142 N HIGH ST APT 103
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1542
Practice Address - Country:US
Practice Address - Phone:614-781-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2649781Medicaid