Provider Demographics
NPI:1538950712
Name:TYSON, ALEXANDRA KRISTEN
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KRISTEN
Last Name:TYSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-3842
Mailing Address - Country:US
Mailing Address - Phone:479-782-1444
Mailing Address - Fax:479-782-1477
Practice Address - Street 1:311 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-3842
Practice Address - Country:US
Practice Address - Phone:479-782-1444
Practice Address - Fax:479-782-1477
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3361225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist