Provider Demographics
NPI:1992174072
Name:RHEA, ALEXA (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:RHEA
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:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-0341
Mailing Address - Country:US
Mailing Address - Phone:208-743-8416
Mailing Address - Fax:208-743-4642
Practice Address - Street 1:2841 JUNIPER DR STE 2
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4719
Practice Address - Country:US
Practice Address - Phone:208-848-9001
Practice Address - Fax:208-848-9002
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCS50718363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical