Provider Demographics
NPI:1689121246
Name:THOMAS, ALEXANDRA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LYNN
Last Name:THOMAS
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 1:1701 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3822
Mailing Address - Country:US
Mailing Address - Phone:712-256-5600
Mailing Address - Fax:712-256-3440
Practice Address - Street 1:1701 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3822
Practice Address - Country:US
Practice Address - Phone:712-256-5600
Practice Address - Fax:712-256-3440
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109945363A00000X
IA083667363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical