1023773744 NPI number — MS. ALEXA NICOLE DESSABLES DNP, ACNP-AG

Table of content: MS. ALEXA NICOLE DESSABLES DNP, ACNP-AG (NPI 1023773744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023773744 NPI number — MS. ALEXA NICOLE DESSABLES DNP, ACNP-AG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESSABLES
Provider First Name:
ALEXA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DNP, ACNP-AG
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023773744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10210 N 92ND STREET, SUITE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85258-1463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-882-7750
Provider Business Mailing Address Fax Number:
480-882-5838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10210 N 92ND ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85258-4525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-882-7750
Provider Business Practice Location Address Fax Number:
480-882-5838
Provider Enumeration Date:
11/08/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC0200X , with the licence number:  RN184086 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LC0200X , with the licence number: 272641 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 272641 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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