MEDICARE: KADIE ALEXANDER

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	364SE0003X	Emergency Clinical Nurse Specialist	13113867-3102	UT

General Provider Information

NPI Number	:	1891652772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KADIE ALEXANDER

Provider Business Mailing Address
First Line	:	1359 E 3000 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 N MEDICAL DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-0001
Country	:	US
Telephone Number	:	508-505-7628
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “ KADIE ALEXANDER ” Practice Location

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