Individual provider Active NPI

Alexa Frances Willard, PA-C

  • Physician Assistant
  • Buffalo, MN
National Provider Identifier
1609451210
Registry record updated Aug 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
15406 Issued in MN
Practice address
3650 Braddock Ave NE Ste 400
Buffalo, MN 55313-3681
Phone
(763) 587-4725
Fax
(952) 883-9604
NPI assigned
Mar 15, 2021
Last updated
Aug 5, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 15406 MN Primary
Physician Assistant 363A00000X MED-PAC-LIC-95816 MT

Addresses

Primary practice location

3650 Braddock Ave NE Ste 400
Buffalo, MN 55313-3681

Mailing address

3650 Braddock Ave NE Ste 400
Buffalo, MN 55313-3681
Phone (763) 587-4725

Other names 1

  • Alexa Frances Thielman Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210526003348 MT Practitioner - Physician Assistant 3779982517 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MED-PAC-LIC-95816MTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. PastSince Mar 6, 2022 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785888000000",
    "number": "1609451210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 BRADDOCK AVE NE STE 400",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553133681",
            "telephone_number": "763-587-4725",
            "fax_number": "952-883-9604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 BRADDOCK AVE NE STE 400",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553133681",
            "telephone_number": "763-587-4725",
            "fax_number": "952-883-9604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLARD",
        "first_name": "ALEXA",
        "middle_name": "FRANCES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-15",
        "last_updated": "2026-08-05",
        "certification_date": "2026-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "15406",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "MED-PAC-LIC-95816",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALEXA",
            "last_name": "THIELMAN",
            "middle_name": "FRANCES",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Buffalo, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.