Provider Demographics
NPI:1346442365
Name:HOLDER, ALEXIS FUSELIER (PA)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:FUSELIER
Last Name:HOLDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:ALEXIS
Other - Middle Name:LEIGH
Other - Last Name:FUSELIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2200 PARK BEND DR
Mailing Address - Street 2:BLDG # 3, SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5387
Mailing Address - Country:US
Mailing Address - Phone:512-467-2727
Mailing Address - Fax:512-873-7576
Practice Address - Street 1:2200 PARK BEND DR
Practice Address - Street 2:BLDG # 3, SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5387
Practice Address - Country:US
Practice Address - Phone:512-467-2727
Practice Address - Fax:512-873-7576
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03794363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03794OtherPA LICENSE NUMBER