Provider Demographics
NPI:1689247207
Name:THEN, YALIXSA (FNP-BC)
Entity type:Individual
Prefix:
First Name:YALIXSA
Middle Name:
Last Name:THEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:570-671-0300
Mailing Address - Fax:570-671-0305
Practice Address - Street 1:624 W CENTRE ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-1403
Practice Address - Country:US
Practice Address - Phone:570-671-0300
Practice Address - Fax:570-671-0305
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF347683363LF0000X
PASP032479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF347683OtherLICENSE #