Basic Information
| Provider Information | |||||||||
| NPI: | 1477143394 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOUTS | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 181 W MEADOW DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | VAIL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816575058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702369900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 181 W MEADOW DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | VAIL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816575058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704761100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2021 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.0006565 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.