Provider Demographics
NPI:1760705206
Name:BRANDON, ALEXIS GUY (PA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:GUY
Last Name:BRANDON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:NICOLE
Other - Last Name:GUY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10345 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5862
Mailing Address - Country:US
Mailing Address - Phone:800-929-0926
Mailing Address - Fax:800-238-6575
Practice Address - Street 1:10345 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5862
Practice Address - Country:US
Practice Address - Phone:800-929-0926
Practice Address - Fax:800-238-6575
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20867363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant