Provider Demographics
NPI:1578192548
Name:WILSON, ALEXIS CHRISTINE (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:CHRISTINE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 BUGGY LN
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-4430
Mailing Address - Country:US
Mailing Address - Phone:909-573-9012
Mailing Address - Fax:
Practice Address - Street 1:11515 TOEPPERWEIN RD STE 101
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3166
Practice Address - Country:US
Practice Address - Phone:210-560-4500
Practice Address - Fax:210-504-2388
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU3694208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program