Provider Demographics
NPI:1306814199
Name:FIDER-WHYTE, ALEXA MARIE (DMSC, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALEXA
Middle Name:MARIE
Last Name:FIDER-WHYTE
Suffix:
Gender:F
Credentials:DMSC, PA-C
Other - Prefix:MS
Other - First Name:ALEXA
Other - Middle Name:MARIE
Other - Last Name:FIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1008 S SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2520
Mailing Address - Country:US
Mailing Address - Phone:314-977-2140
Mailing Address - Fax:314-977-2141
Practice Address - Street 1:1225 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-257-3760
Practice Address - Fax:314-257-3761
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005017774363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical