Provider Demographics
NPI:1700244811
Name:THUET, ALEXANDRA FERGUSON (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:FERGUSON
Last Name:THUET
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 1:98 N 1100 E STE 101
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2940
Mailing Address - Country:US
Mailing Address - Phone:801-842-9078
Mailing Address - Fax:
Practice Address - Street 1:98 N 1100 E STE 101
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2940
Practice Address - Country:US
Practice Address - Phone:801-842-9078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9653131-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical