Provider Demographics
NPI:1194303784
Name:WAHLEN, ALEXIS RENEE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RENEE
Last Name:WAHLEN
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7827 CASTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4124
Mailing Address - Country:US
Mailing Address - Phone:361-944-4189
Mailing Address - Fax:
Practice Address - Street 1:4499 MEDICAL DR STE 166
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3771
Practice Address - Country:US
Practice Address - Phone:210-575-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017381363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily