Provider Demographics
NPI:1144698903
Name:LANDON, ALEXANDRA MARIE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:MARIE
Last Name:LANDON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1515 S CLIFTON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2953
Mailing Address - Country:US
Mailing Address - Phone:316-858-0550
Mailing Address - Fax:316-858-0596
Practice Address - Street 1:1515 S CLIFTON AVE STE 300
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218
Practice Address - Country:US
Practice Address - Phone:316-858-0550
Practice Address - Fax:316-858-0596
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501826363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201122810EMedicaid
KS201122810EMedicaid