ALYSSA PROLLOCK RD
NPI 1215614409
Dietitian, Registered - Nutrition, Oncology in Fairbanks, AK

Active since June 29, 2023Accepts Medicare Assignment
1640 COWLES ST, FAIRBANKS, AK 99701(907) 458-5629 Get Directions Write a Review

NPPES record last updated: June 29, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Alyssa Prollock Rd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ALYSSA PROLLOCK RD (NPI 1215614409) is an individual nutrition, oncology provider in Fairbanks, Alaska, licensed in Alaska (208636) and active in the NPI registry since June 2023. She is a graduate of Other (2014).

NPPES Registry Identity

NPI1215614409
Entity TypeIndividualFemale
Primary Taxonomy133VN1301X
Provider Legal NameALYSSA PROLLOCKCredential: RD
Location Address1640 COWLES STFairbanks, AK 99701-5908
Mailing Address3981 Buckeye Ln Apt 1Fort Wainwright, AK 99703-1609 · (404) 414-5431
Sole ProprietorNo
Medical School CMSOtherGraduated 2014
Enumeration DateJune 29, 2023
NPPES CertifiedJune 27, 2023
NPI 1215614409 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDietitian, Registered · Nutrition, OncologyDietary & Nutritional Service Providers
Taxonomy Code133VN1301X
License Licensed in AK · 208636
Definition

An individual who is a Board Certified Specialist in Oncology Nutrition and provides direct nutrition care for individuals at risk for or diagnosed with cancer. RDNs working directly with individuals at risk for, or diagnosed with, any type of malignancy or pre-malignant condition, in a variety of settings (e.g. hospitals, clinics, cancer centers, hospices, public health), OR indirectly through roles in management, education, industry, and research practice linked specifically to oncology nutrition. RDN who works indirectly with oncology nutrition through roles in management, education, industry, and research.

1640 COWLES ST, Fairbanks, AK 99701

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Alyssa Prollock Rd is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4981044088
PECOS Enrollment IDI20240506001390

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Internal Medicine (Hematology & Oncology)
1640 COWLES ST, SUITE 1
FAIRBANKS, AK 99701
Internal Medicine (Hematology & Oncology)
1640 COWLES ST, SUITE 1
FAIRBANKS, AK 99701
Physician Assistant
1640 COWLES ST, SUITE 1
FAIRBANKS, AK 99701
Nurse Practitioner
1640 COWLES ST, SUITE 1
FAIRBANKS, AK 99701
Internal Medicine (Hematology & Oncology)
1640 COWLES ST
SUITE 1, AK 99701
Physician Assistant
1640 COWLES ST
FAIRBANKS, AK 99701

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Alyssa Prollock's NPI number?

The NPI number for Alyssa Prollock is 1215614409. It was assigned to this individual provider in the NPPES registry on June 29, 2023.

Where is Alyssa Prollock located?

Alyssa Prollock practices at 1640 Cowles St, Fairbanks, AK 99701. The listed phone number is (907) 458-5629.

What is Alyssa Prollock's specialty?

The primary specialty registered for this NPI is Dietitian, Registered, specializing in Nutrition, Oncology, with taxonomy code 133VN1301X.

Is Alyssa Prollock enrolled in Medicare?

Yes. Alyssa Prollock is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Alyssa Prollock was last updated on June 29, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.