Provider Demographics
NPI:1508137217
Name:ALEXIA, LISA M (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:ALEXIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W BENSON BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3677
Mailing Address - Country:US
Mailing Address - Phone:907-929-4009
Mailing Address - Fax:907-929-4902
Practice Address - Street 1:1400 W BENSON BLVD STE 315
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3677
Practice Address - Country:US
Practice Address - Phone:907-929-4009
Practice Address - Fax:907-929-4902
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
AK2224363A00000X
AK1076363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDH0105Medicaid