Provider Demographics
NPI:1285977355
Name:KESSELMAN, ALYSSA LAUREN (CPNP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LAUREN
Last Name:KESSELMAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N MEDICAL PKWY
Mailing Address - Street 2:PEDIATRICS
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-7031
Mailing Address - Country:US
Mailing Address - Phone:770-517-1900
Mailing Address - Fax:770-926-3215
Practice Address - Street 1:145 N MEDICAL PKWY
Practice Address - Street 2:PEDIATRICS
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-7031
Practice Address - Country:US
Practice Address - Phone:770-517-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201497363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics