1972517100 NPI number — MRS. STACY A. ALEXANDER PA-C

Table of content: MRS. STACY A. ALEXANDER PA-C (NPI 1972517100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972517100 NPI number — MRS. STACY A. ALEXANDER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEXANDER
Provider First Name:
STACY
Provider Middle Name:
A.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1972517100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 N BAILEY MAE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY CENTER
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67147-4011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-744-7924
Provider Business Mailing Address Fax Number:
316-259-1972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6100 E CENTRAL AVE STE 3
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67208-4237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-689-5235
Provider Business Practice Location Address Fax Number:
316-691-6788
Provider Enumeration Date:
07/27/2006

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: 363A00000X , with the licence number:  15-00973 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110173325 . This is a "MEDICARE - VCPG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110999006 . This is a "MEDICARE - WT MGMT" identifier . This identifiers is of the category "OTHER".




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