Provider Demographics
NPI:1457829780
Name:TIPPETTS, ALEXANDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:TIPPETTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLY
Other - Middle Name:
Other - Last Name:KOTTCAMP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 912042
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-2042
Mailing Address - Country:US
Mailing Address - Phone:435-215-0230
Mailing Address - Fax:435-986-7092
Practice Address - Street 1:2891 E MALL DR STE 101
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2399
Practice Address - Country:US
Practice Address - Phone:435-688-1634
Practice Address - Fax:435-688-1635
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1139789363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant