Provider Demographics
NPI:1073931804
Name:ROONEY, LEXY JADE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LEXY
Middle Name:JADE
Last Name:ROONEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LEXY
Other - Middle Name:JADE
Other - Last Name:TEETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:810 RAVENHILL DR
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-9204
Mailing Address - Country:US
Mailing Address - Phone:913-674-2340
Mailing Address - Fax:
Practice Address - Street 1:820 RAVENHILL DR
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-9268
Practice Address - Country:US
Practice Address - Phone:913-674-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-29
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501689363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant