Alissa Marjorie Stockton, L.AC., D.O.M.

Key facts

NPI

1871662593

Entity type

Individual (NPI type 1)

Primary specialty

Acupuncturist 171100000X

License

AZ0373 (AZ)

Practice address

1059 N. College Ave.
Thatcher, AZ 85552

Phone

(928) 965-9545

NPI assigned

Nov 7, 2006

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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

• Green Mountain Wellness Acupuncturist · Thatcher, AZ · NPI 1497369730
  NPD Authorized official ACUPUNCTURIST

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

Other names

• Mrs. Alissa Marjorie Polen Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 26, 2015.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432598400000",
    "number": "1871662593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1059 N. COLLEGE AVE.",
            "address_2": "PO BOX 1119",
            "city": "THATCHER",
            "state": "AZ",
            "postal_code": "85552",
            "telephone_number": "928-965-9545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1059 N. COLLEGE AVE.",
            "city": "THATCHER",
            "state": "AZ",
            "postal_code": "85552",
            "telephone_number": "928-965-9545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOCKTON",
        "first_name": "ALISSA",
        "middle_name": "MARJORIE",
        "name_prefix": "Mrs.",
        "credential": "L.AC., D.O.M.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2015-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "AZ",
            "license": "0373",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "AZ",
            "license": "AZ0373",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCAOM",
            "identifier": "015873",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALISSA",
            "last_name": "POLEN",
            "middle_name": "MARJORIE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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