MEDICARE: ALEXANDRA LYNN THEILE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA20016	TX

General Provider Information

NPI Number	:	1083567168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA LYNN THEILE PA-C

Provider Business Mailing Address
First Line	:	3227 EAGLEWOOD DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-9481
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11920 ASTORIA BLVD STE 410
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-6097
Country	:	US
Telephone Number	:	281-480-6264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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