Provider Demographics
NPI:1811515067
Name:FOUTS, LEXIS
Entity type:Individual
Prefix:
First Name:LEXIS
Middle Name:
Last Name:FOUTS
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 1:617 W TAYLOR AVE # A
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2411
Mailing Address - Country:US
Mailing Address - Phone:208-964-5936
Mailing Address - Fax:
Practice Address - Street 1:617 W TAYLOR AVE # A
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2411
Practice Address - Country:US
Practice Address - Phone:208-964-5936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty