MEDICARE: DEDRA ALEXANDER APRN

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	163WG0000X	General Practice Registered Nurse	RN097415	LA
2	363LF0000X	Family Nurse Practitioner	213891	LA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	213891	LA

General Provider Information

NPI Number	:	1033694955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEDRA ALEXANDER APRN

Provider Business Mailing Address
First Line	:	PO BOX 12021
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70612-2021
Country	:	US
Telephone Number	:	337-368-5801
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 S HUNTINGTON ST
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70663-4419
Country	:	US
Telephone Number	:	337-965-9921
Fax Number	:

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

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	10/24/2024

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