Provider Demographics
NPI:1629656186
Name:FITZGERALD, ALEXIS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:
Last Name:FITZGERALD
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 1:5875 ROSS AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-8493
Mailing Address - Country:US
Mailing Address - Phone:512-538-8626
Mailing Address - Fax:
Practice Address - Street 1:1141 KINWEST PKWY STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3512
Practice Address - Country:US
Practice Address - Phone:214-239-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine