MEDICARE: ALEXANDRA PARRIS HENRY

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	363AM0700X	Medical Physician Assistant	0010-16119	NC
2	106S00000X	Behavior Technician
3	363AM0700X	Medical Physician Assistant	23.006776	CT

General Provider Information

NPI Number	:	1679065882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA PARRIS HENRY

Provider Business Mailing Address
First Line	:	2414 LAKEVIEW CIR
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-7555
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9723 NORTHEAST PKWY STE 100
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-9719
Country	:	US
Telephone Number	:	980-262-3007
Fax Number	:

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

Provider Enumeration Date	:	06/04/2018
Last Update Date	:	03/06/2026

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