Provider Demographics
NPI:1922029719
Name:FOX, ALETA JEAN (PA)
Entity type:Individual
Prefix:MS
First Name:ALETA
Middle Name:JEAN
Last Name:FOX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2724 LONNIE LN
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:MO
Mailing Address - Zip Code:64865-8519
Mailing Address - Country:US
Mailing Address - Phone:918-533-4634
Mailing Address - Fax:
Practice Address - Street 1:4301 HOWARD BUSH DR
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-9104
Practice Address - Country:US
Practice Address - Phone:417-212-7144
Practice Address - Fax:833-972-1618
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK942363AM0700X
MO2024002454363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200468380OMedicaid
OK100150140BMedicaid
OK100150140DMedicaid
OK100150140DMedicaid
OK100150140BMedicaid