Alyssa Prollock, RD

Primary specialty

Oncology Nutrition Registered DietitianTaxonomy code 133VN1301X

License

208636 Issued in AK

Practice address

1640 Cowles St
Fairbanks, AK 99701-5908

Phone

(907) 458-5629

NPI assigned

Jun 29, 2023

Last updated

Jun 29, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tanana Valley Clinic LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1922559558
  Medicare reassignment NPD
• Tanana Valley Clinic LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1073081485
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1215614409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3981 BUCKEYE LN APT 1",
            "city": "FORT WAINWRIGHT",
            "state": "AK",
            "postal_code": "997031609",
            "telephone_number": "404-414-5431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 COWLES ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015908",
            "telephone_number": "907-458-5629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROLLOCK",
        "first_name": "ALYSSA",
        "credential": "RD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-29",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1301X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Oncology",
            "state": "AK",
            "license": "208636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Procare Home Medical, Inc. (Procare Home Medical)
• Holly Proell, PT-CLT
• Professional Pharmacy LLC (Professional Pharmacy)
• Professional Pharmacy LLC (Alaska Family Pharmacy)
• Professional Pharmacy LLC (Alaska Family Pharmacy)
• Jason Patrick Proud, DPT
• Gina Pruce, MA
• Connor David Puetzer
• Rebecca Anne Puetzer
• George Denali Purvis

• Registered Dietitian in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Registered Dietitian in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.