Provider Demographics
NPI:1871981001
Name:KESLING, ALYSSA ROSE (PA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ROSE
Last Name:KESLING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:ROSE
Other - Last Name:MANGABAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2030 SUTTER PL STE 1000
Practice Address - Street 2:DAVIS MOB INTERNAL MEDICINE #1000
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6215
Practice Address - Country:US
Practice Address - Phone:530-750-5904
Practice Address - Fax:530-750-5905
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant