Provider Demographics
NPI:1578300679
Name:OPEL, ALEXIS LYNN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:LYNN
Last Name:OPEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22131 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-9123
Mailing Address - Country:US
Mailing Address - Phone:309-231-9342
Mailing Address - Fax:
Practice Address - Street 1:3422A COURT ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6235
Practice Address - Country:US
Practice Address - Phone:309-477-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085010495363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant