Individual
ALISSA M MOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2120 LIVE STRONGER ST, TEA, SD 57064-8331
(605) 331-5890
Mailing address
2120 LIVE STRONGER ST, TEA, SD 57064-8331
(605) 331-5890
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0584
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
682750
—
SD
01
—
P00227328
RAILROAD MEDICARE
SD
Enumeration date
07/09/2006
Last updated
04/21/2026
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