Provider Demographics
NPI:1508449976
Name:RHODES, ALEXIS NIKOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NIKOLE
Last Name:RHODES
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:PO BOX 3397
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3397
Mailing Address - Country:US
Mailing Address - Phone:503-717-7443
Mailing Address - Fax:
Practice Address - Street 1:171 N LARCH ST STE 16
Practice Address - Street 2:
Practice Address - City:CANNON BEACH
Practice Address - State:OR
Practice Address - Zip Code:97110-3103
Practice Address - Country:US
Practice Address - Phone:503-717-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA214256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant