Provider Demographics
NPI:1376283226
Name:ANCIRO, ALYSSA MONICA
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MONICA
Last Name:ANCIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:ANCIRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2 TRILLIUM WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8426
Mailing Address - Country:US
Mailing Address - Phone:606-526-4070
Mailing Address - Fax:606-526-4072
Practice Address - Street 1:2 TRILLIUM WAY STE 106
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8426
Practice Address - Country:US
Practice Address - Phone:606-526-4070
Practice Address - Fax:606-526-4072
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP493207Q00000X
KYR6357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine