Provider Demographics
NPI:1861742629
Name:FUNK, ALYSIA RENEE (FNP-BC)
Entity type:Individual
Prefix:MISS
First Name:ALYSIA
Middle Name:RENEE
Last Name:FUNK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:198 MORGANTOWN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BRUCETON MILLS
Mailing Address - State:WV
Mailing Address - Zip Code:26525-5003
Mailing Address - Country:US
Mailing Address - Phone:304-379-7600
Mailing Address - Fax:334-488-0358
Practice Address - Street 1:198 MORGANTOWN ST STE 2
Practice Address - Street 2:
Practice Address - City:BRUCETON MILLS
Practice Address - State:WV
Practice Address - Zip Code:26525-5003
Practice Address - Country:US
Practice Address - Phone:304-379-7600
Practice Address - Fax:833-448-0362
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV52464363LF0000X
WVAPRN52464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily