Healthcare Provider Details

I. General information

NPI: 1598247520
Provider Name (Legal Business Name): ALEXIS HUSS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 TULLAMORE AVE STE C
BLOOMINGTON IL
61704-9603
US

IV. Provider business mailing address

1709 TULLAMORE AVE STE C
BLOOMINGTON IL
61704-9603
US

V. Phone/Fax

Practice location:
  • Phone: 309-454-5900
  • Fax: 309-454-2820
Mailing address:
  • Phone: 309-454-5900
  • Fax: 309-454-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.008849
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: