Provider Demographics
NPI:1154706885
Name:KRAUSE, ALEXA KYL (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:KYL
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 DIAMOND PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-4321
Mailing Address - Country:US
Mailing Address - Phone:816-561-3003
Mailing Address - Fax:816-303-2484
Practice Address - Street 1:1950 DIAMOND PKWY STE 100
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-4321
Practice Address - Country:US
Practice Address - Phone:816-561-3003
Practice Address - Fax:816-303-2484
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA079139OtherIOWA PHYSICIAN ASSISTANT LICENSE