Provider Demographics
NPI:1790969046
Name:PAULSON, ALEXIS BARTLEY (RN, APN)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BARTLEY
Last Name:PAULSON
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:NICOLE
Other - Last Name:BARTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, APN
Mailing Address - Street 1:1325 E CHURCH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5915
Mailing Address - Country:US
Mailing Address - Phone:805-346-3456
Mailing Address - Fax:805-346-3454
Practice Address - Street 1:1325 E CHURCH ST STE 202
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5915
Practice Address - Country:US
Practice Address - Phone:805-346-3456
Practice Address - Fax:805-346-3454
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034678363L00000X
TN12974363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3371594Medicare PIN