Provider Demographics
NPI:1831807080
Name:POKLUDA, ALEXA ANN (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:ANN
Last Name:POKLUDA
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:ANN
Other - Last Name:MAGNOTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9509 N BEACH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6399
Mailing Address - Country:US
Mailing Address - Phone:817-741-4347
Mailing Address - Fax:
Practice Address - Street 1:9509 N BEACH ST STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6399
Practice Address - Country:US
Practice Address - Phone:817-741-4347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program