Provider Demographics
NPI:1225486160
Name:THEISEN, ALEXANDRA NICOLE (MD, MS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:THEISEN
Suffix:
Gender:F
Credentials:MD, MS
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Mailing Address - Street 1:1 CHILDRENS WAY # 653
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:501-364-4082
Practice Address - Street 1:1 CHILDRENS WAY # 512
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1100
Practice Address - Fax:501-364-4052
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2024-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE-17953208000000X, 2080P0216X
MO2022019876208000000X, 2080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics