Provider Demographics
NPI:1861788895
Name:TAYLOR, ALEXIS V (PA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:V
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:VALESKA
Other - Last Name:PODUSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-6000
Mailing Address - Fax:515-643-6001
Practice Address - Street 1:5615 NW 86TH ST
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1738
Practice Address - Country:US
Practice Address - Phone:515-643-6000
Practice Address - Fax:515-643-6001
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002237363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant