Provider Demographics
NPI:1063468999
Name:ANTHONY, ALEXIS R (PA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:R
Last Name:ANTHONY
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 WILLIAMS ST
Mailing Address - Street 2:STE 300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1234
Mailing Address - Country:US
Mailing Address - Phone:303-388-4876
Mailing Address - Fax:303-336-3079
Practice Address - Street 1:2265 NC HIGHWAY 24 27 E
Practice Address - Street 2:
Practice Address - City:BISCOE
Practice Address - State:NC
Practice Address - Zip Code:27209-9758
Practice Address - Country:US
Practice Address - Phone:910-828-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12727363A00000X
CO2047363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94571341Medicaid