Provider Demographics
NPI:1558044412
Name:CHALLY, ALEXIA MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:ALEXIA
Middle Name:MARIE
Last Name:CHALLY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 RED CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IA
Mailing Address - Zip Code:50109-4732
Mailing Address - Country:US
Mailing Address - Phone:319-929-8306
Mailing Address - Fax:
Practice Address - Street 1:1215 PLEASANT ST STE 303
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1422
Practice Address - Country:US
Practice Address - Phone:319-929-8306
Practice Address - Fax:515-241-6533
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA153544208000000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208000000XAllopathic & Osteopathic PhysiciansPediatrics